American College of Physicians: Internal Medicine — Doctors for Adults ®

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Gaming the hospital

From the November ACP Hospitalist, copyright © 2013 by the American College of Physicians

By Stacey Butterfield

Hospital medicine is both work and play to James J. Fulmer, MD, FACP.

As site director of the downtown team of hospitalists for Baptist Primary Care in Jacksonville, Fla., Dr. Fulmer works full-time as a hospitalist. But several years ago, he noticed the game-like aspects of his duties.

Photo courtesy of James J. Fulmer.

Photo courtesy of James J. Fulmer.



“I was thinking of how taking care of patients is kind of like playing chess,” he said, due to the many roles and ever-evolving strategy involved. That insight led him to develop a board game based on hospital practice, called Doctor Wars.

At first just an entertainment for his family drawn up on a piece of poster board, the game has evolved into a professionally designed, commercially available product, with about 300 sets sold. “Over 10 years, I played with lots and lots of different people and changed the rules every time, based on their suggestions,” said Dr. Fulmer.

The multi-player game, which is intended for 2 to 4 players ages 10 and up, includes pieces for attendings, residents, interns and nurses (“The attending is the king, and the intern is the pawn who moves around the board really fast,” said Dr. Fulmer) and a board divided into medical, surgical, cardiac, neurology, GI and pulmonary wards.

In addition to the setup, many of the game's challenges and jokes echo hospitalist practice. “If you move a nurse into a ward, no intern or resident can get into that ward,” Dr. Fulmer said. “There's a lot of inside jokes on the cards, like interns fetching coffee for the attending, and the attending goes to a conference in Tahiti … We have a CPR card, where if you roll evens the person lives, you roll odds the person dies.” The player who successfully treats and discharges the most patients wins the game.

Even the production of the game was rooted in his hospital practice. “A nutritionist at the hospital mentioned in casual conversation that her husband was a professional designer,” he said. After working on the game, the designer then connected Dr. Fulmer with a professional who could produce the board.

The flexibility of a hospitalist schedule has made it possible for Dr. Fulmer to develop the game while still working full-time. “Being a hospitalist is perfect, because there's usually some way to create your schedule so you can have time to do your creative side,” he said.

Up next on his creative schedule is the writing of children's stories and the marketing of Doctor Wars, including a booth in the exhibit hall at Internal Medicine 2014. The game is also available online.

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Fast facts

Medical school: University of Massachusetts Medical School, Worcester, Mass.

Residency: Brown University General Internal Medicine at Rhode Island Hospital in Providence.

Current job: Site director of the downtown team of hospitalists for Baptist Primary Care in Jacksonville, Fla.

Something I wish I'd learned in medical school: That I can be a physician and also foster my creativity.

First job as a physician: I worked at the Duval County Public Health Department and helped found Jacksonville's first public AIDS clinic and WE CARE, a volunteer physician program for underserved people in the city.

Most meaningful professional accomplishment: Helping to grow the Baptist Primary Care hospitalist team from 4 to more than 50 physicians.

Hardest medical lesson learned: Evidence-based medicine is an important part of the equation, but not the entire equation when you're dealing with real people. Effective human interaction remains essential.

Pet peeves: Ineffective, noisy hospital alarm systems and other inefficiencies that negatively impact patients' experience.

Most recent book read: “The Untethered Soul: The Journey Beyond Yourself” by Michael A. Singer.

Item I can't live without: Soap.

Most surprising thing about me: My wife and I won disco contests in the 70's.

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