One of the more frustrating experiences a hospitalist can have is to treat and discharge a substance-abusing patient, only to suspect that he or she will be right back in the hospital weeks or days later. Screening and treatment coordination for such patients are relatively rare, yet some hospitals have made a concerted effort in this area and seen impressive results. Our cover story looks at how hospitalists can quickly detect substance abuse, and their role in explaining to patients the impact of abuse on overall health. In addition, we profile individual hospital programs that have made it easy for doctors to connect patients with treatment while maintaining their usual workflow.
Another area where physician referrals are scant is cardiac rehabilitation. Though research shows this outpatient therapy reduces readmissions and improves mortality for those recently hospitalized for a cardiac event, few patients actually make it to rehab after discharge. Our story discusses which patients should and shouldn't be targeted for referral, as well as methods hospitals can use to encourage and simplify the referral process for hospitalists and other staff.
On the other end of the referral spectrum is medical testing. Potential overuse of CT scans has gained considerable attention in recent years, both from those concerned about possible health effects and those who think it may contribute to out-of-control health care spending. Indeed, CT scanning in the U.S. has increased more than twentyfold since 1980. Our story examines some of the potential consequences and what doctors can do to ensure they are ordering tests appropriately.
Also in this issue, third-year resident Anthony Rudine kicks off a new occasional feature, Self-Examination, in which contributors reflect on how practicing medicine affects one's personal life—and vice versa. Newman's Notions muses on the role of serendipity in the practice of medicine. Finally, read our coverage of the annual Medical Group Management Association conference to learn how to improve compliance in the hospital, and how to help warring physicians get along better.
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Editor, ACP Hospitalist