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Textbook reflects evolution of hospitalists

From the February ACP Hospitalist, copyright © 2017 by the American College of Physicians

By Mollie Durkin

Medical textbooks bear the difficult task of keeping up with health care's constant changes. This year, however, the latest in hospital medicine knowledge is fresh off the press, with the first update of “Principles and Practice of Hospital Medicine” since its publication in 2012.

The textbook's second edition, edited by Sylvia McKean, MD, FACP; John Ross, MD; Daniel D. Dressler, MD, FACP; and Danielle Scheurer, MD, was released in December 2016 by ACP's publishing partner, McGraw-Hill, and features nearly 500 contributors. The print version is now available online (with a discount for ACP members), as well as from other book retailers. The text's digital version is available through Kindle and McGraw-Hill's subscription-based platform, AccessMedicine.

Dr. McKean, the chief editor, recently spoke with ACP Hospitalist about the new book.

Q: Why was there a need for a second edition?

A: Medicine is rapidly evolving, so the changes reflect how hospital medicine and the specialties within hospital medicine have changed since initial publication. For example, the second edition provides more robust coverage of consultation medicine, rehabilitation medicine, oncology, palliative care, and transitions of care.

Q: How is the book organized?

A: The second edition has six major parts designed to cover issues of importance to hospitalists.

Part one, the specialty of hospital medicine and systems of care, addresses value-based medicine, critical decision making at the point of care, transitions of care, patient safety, and quality improvement.

Part two, medical consultation, explains what you really need to know about surgical patients in your role as a consultant.

Part three, rehabilitation and skilled nursing care, is a new addition written primarily by experts in rehabilitation medicine.

Part four, the approach to the patient at the bedside, includes common problems that may arise during hospitalization. This part focuses on vital signs, the physical examination, and initial laboratory tests that might help guide further diagnostic testing and specialty consultation. Approach to the patient at the bedside may be especially useful for nocturnists admitting patients overnight.

Part five, diagnostic testing and procedures, reviews the interpretation of tests usually obtained at the time of hospital admission. The procedure section highlights indications of procedures commonly performed by some hospitalists, the initial assessment, and prevention of complications.

Part six, clinical conditions in the inpatient setting, differs from textbooks that review major disciplines in internal medicine, such as cardiology, gastroenterology, and infectious disease, in that the focus is entirely on clinical conditions that require or arise during hospitalization. In addition, there are sections that have a particular relevance to the specialty of hospital medicine (e.g., high-value care, toxicology and addiction, palliative care, and geriatrics).

Q: Who should read this book? Is it intended for both practicing hospitalists and trainees?

A: Yes, and for other clinicians who attend on the wards, such as physician assistants and nurse practitioners. In addition, this textbook may be a useful resource for nonhospitalist attendings who care for inpatients, such as teaching attendings and medical subspecialists, and for physicians studying for recertification in the boards of internal medicine.

Q: How does the new edition address high-value care?

A: Traditional, fee-for-service internal medicine doesn't factor in cost or the value of a procedure. Incumbent on all people practicing in the hospital is a consideration of risk versus benefit of each approach to diagnosis and treatment. Does this test or procedure change management by adding value to the person? To answer this question, the clinician must consider the care plan in the context of the prognosis for the patient, communicate this information to the patient, and understand the patient's values and preferences. The first edition covered high-value care, but not as explicitly as in the second edition.

Q: Has anything from the prior edition been deleted or otherwise changed drastically?

A: We eliminated several chapters and combined others into existing chapters for less redundancy. We also tried to shorten each chapter, even if we didn't delete it. This edition is about 200 pages shorter despite adding some new content. Five chapters [in an electronic feature separate from the textbook] are exclusively on AccessMedicine. These chapters provide an overview of global health, the economics of hospital care, principles of medical ethics, the core competencies of hospital medicine, and bioterrorism.

Q: How would a practicing hospitalist reference this book?

A: For a provisional admission diagnosis of, for example, pneumonia, clinicians need to confirm a diagnosis of pneumonia, prescribe appropriate antibiotics, modify the treatment regimen when test results become available, and make recommendations about the duration of treatment. This textbook provides practical information about initial testing, chest radiology interpretation, and the diagnosis of different types of pneumonia. A hospitalist might then refer to the infectious disease section in part six of the textbook; the chapters on hospital-acquired pneumonia and community-acquired pneumonia provide specific recommendations at the point of care.

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