Newman’s Notions


Byzantine

Whether it's ancient Persian credentialing, colonial American utilization review, or medieval admission criteria, the things that drive us mad today did the same to our distant medical forbearers.

Ignaz and Cassandra

Two voices called out warnings, but they fell on deaf ears.

Lost

Was there a true psychological reason for losing stuff all the time?

Dumb luck

Rounds went very smoothly, until we got to Mr. Fibonacci.

The internet of things to come

Technology isn't always as helpful as it seems.

Notes from the field: Hospital medicine in Japan

In Japan, hospital medicine may help to resolve several pressing issues, the biggest being the aging population.

Initial assessment

When you've spent as much time in a hospital as I have over the years, you tend to develop a sixth sense as to when something isn't quite right

Hospital Servi-Sisyphus

It was that kind of morning: hypertensive patients who couldn't pay for their meds and little old ladies, sweet and otherwise, who kept on falling

Discharge meds

A patient's request presents an ethical dilemma

A newfangled column

The first stethoscope was created with a rolled-up sheaf of papers in 1816

Physician biomarkers

Astounding differences have been found in the gene expression of the various archetypes of physicians haunting hospital halls

Elevator pitch

A good pitch must be concise and clear, engaging and persuasive, well-rehearsed and actionable, and less than 30 seconds long

Colica Pictonum

Ancient Rome and Flint, Mich., share a connection

Little's Law and you

To understand what's really happening in your hospital, you need to consider Little's Law

Hospital medicine in India

Last December, speakers from several countries joined their colleagues in Kochi, India, to discuss clinical administrative, and education issues during a multi-day conference

Armadillo exposure, subsequent encounter

If there is no code for it in ICD-10, there is no way I could have an armadillo-related disease

Apophenia

There is a black cloud hanging over your head--the universe is out to get you

Sedimentation

One of the first descriptions of the erythrocyte sedimentation rate is detailed in a book by British surgeon and anatomist John Hunter

The little brown bottle

The first documented recommendation of nitroglycerin for angina pectoris was described by Dr. William Murrell in 1877

Magnificent maggots

Sometimes the best treatment plan can include an effective and simple intervention of antiquity

Morpheus

For thousands of years, ancient civilizations in Asia Minor have been cultivating the opium poppy

Choosing unwisely

A fictionalized ED visit for a simple cut spins wildly out of control

Committee life

Members of a hospital committee see each other in very different ways

Almost a 5-star column

The "Great Satisfaction Madness" of 2027 is over

House of Cards-iology

Hospital administration can sometimes be ruthless

Pott-y language

Tuberculosis with spinal involvement is often referred to as Pott's disease

The lost cohort

A fictional class for an MHA leads to some literal wayfinding

A handy-dandy recommendation letter

A tongue-in-cheek template for handling recommendation requests

The case of the undulant ungulate

A graduate student discovers the dangers of gourmet roadkill.

Simulation and reality

The author recounts his mother's career as a simulated patient.

Dusty grapes

When planning a conference, you can't please everyone.

The chairman of the bored

An adventure in hospital committee participation.

Aphorism-based medicine

Analyzing medical truisms can help us understand how medicine has progressed over time.

High efficiency

A fictional tale about the need to balance speed with thoughtfulness.

Vital signs are vital: The history of pulse oximetry

It will likely surprise younger physicians to know that the modern pulse oximeter was not invented until the early 1970s and did not become commercially available until the 1980s.

Vital signs are vital: Sphygmology

There is much more to checking a pulse than noting its presence or absence.

Vital signs are vital: Focus on fever

Human body temperature must rank as one of the earliest "vital signs" recognized by our ancestors.

Vital signs are vital: Focus on blood pressure

Three case-based scenarios offer both common and unusual presentations of hypertension in hospitalized patients.

Vital signs are vital

Introducing a new series that highlights the importance of vital signs.

The new observation status

Here's the lowdown on the good, the bad and the ugly of the new CMS regulations.

Eponymous chest pain

A hectic day is made worse by a know-it-all fellow.

The unusual occurrences in room 687

An earnest young doctor finds himself practicing medicine in a whole other dimension.

Quincke's legacy

This nineteenth-century physician described angioedema, invented diagnostic lumbar puncture and described a sign of aortic insufficiency, but was still rejected for a Nobel Prize.

Dungeons and doctors

A new way to teach students is modeled after a popular game.

How to stay safe

Safety--in the hospital and in life--is about more than following prescribed systems.

A palette of patients

When in the throes of illness, a patient can project one of a wide range of hues.

Yiddish for hospitalists

After our Latin primer for hospitalists, it only seems right to explore another language that's likely to be of great help.

Pimp my service

I should have been more nervous. Everyone else on the service was.

A looney tenens

This month's column presents a fictional look at a very cartoonish hospital.

The one that got away

I was ready to reel in the diagnosis I was fishing for, only to feel it swim away on an emetic river of blood.

The center of your universe

You start your morning rounds. You will spend the next 12 hours here. This is your world. And you are the center of it.

Get 'er done

A fictional doctor embarks on a quest to place a dialysis catheter.

Food for thought

Take a humorous look at a fictional doctor's quest to get some food during a busy day.

Latin for hospitalists

Here are the top 10 useful Latin phrases for hospitalists for 2012.

Quality time

What would happen if quality measures were applied to your personal life?

The hospital-list

These 10 hospitals have a huge amount of historical significance.

Newbie

Find out what it's like to be a patient in a hospital full of new doctors.

Generic discharge summary

What's lost in accuracy will be more than compensated with personal time saved.

Rounds in motion

Our goal was to round with precision, though it was more likely we would meander due to the effects of Brownian motion, bouncing randomly around the hospital, starting at one point and ending up somewhere else.

In like Flint

The Austin Flint murmur was named for a physician who disliked eponyms.

The apocalyptic hospitalist

A PubMed search for the phrase "end of the world" had no matches, so we must make certain assumptions in this report.

Groundhog shift

I'd seen that movie. Could it really be happening to me?

Food for thought

A Thanksgiving meal develops disturbing medical connotations.

A jolly old locums

A locums assignment in a northern region leads to an unusual patient.

Life is sweet: An extremely brief history of diabetes

One thousand years before Hippocrates, healers knew that the passing of too much urine was a bad sign.

The wisdom of teens

Our editorial advisor learns a thing or two about diagnosis from an unusual source: his teenage son.

August 1865

An important transition occurred in medicine nearly 250 years ago.

First call: 1985

Our editorial advisor remembers his first night on call.

Dressed to kill

A doctor's elegant attire causes trouble in more ways than one.

Hospital failure

Like a conscientious physician, hospitalists must play doctor to their own facilities.

Stair wars

I came to an agreement with the medical students on service with me: We would spend our week "elevator-free."

A day in the life: The hospital playlist

A typical hospitalist's day if set to music would go a little something like this.

Safety first

I know I need to get up and get started, get my children ready for school... and I have an early morning meeting to which I just can't be late.

The fantasy hospitalist league

What if there were a fantasy league for hospitalists?

A lesson in serendipity

Sometimes after a hard morning of rounding, I hide in my office and distract myself by reading a tome from the past.

Day of the undead: The zombie intern

I didn't think my fellow first-years were really worried about my consuming them, but you never know about the strange prejudices of the living.

Hospital medicine in Chile

The international hospitalist movement continues to grow, especially in South America.

That smell

Certain diseases have characteristic odors.

Hospital medicine in Portugal

Our editorial advisor reports from the 16th National Portuguese Congress of Internal Medicine.

Iatrogenica

A chance encounter with an old friend leads our editorial advisor to reminisce about patients past.

Heroic measures

A locum tenens has a strange experience at a new hospital.

Ruppy: Teaching old dogs new tricks

By focusing on teamwork, communication, and strong relationships, successful collaboration between clinicians and other providers can be achieved.

The fascinating foxglove

We were rounding on the hospital service when one of our patients, already hypotensive, went into atrial fibrillation. The most appropriate drug wound up being one with a long and illustrious history.

Write it up

The source of my tension on this particular day was Karin, the incredibly intense fourth-year medical student rounding with me.

Going up, please

Every morning, our team faced the same difficult decision: going up the stairs or getting on the elevator.

The write stuff

Have you ever been given a prescription from your physician that was completely illegible?

Fight the noise

We all know the difficulty in functioning within a noisy hospital. But in hospitals we don't always have the option of suggesting that we move our discussion to a quiet coffee shop instead. Noise pollution in hospitals is an issue that confronts us all as hospital workers.

Locum terror

Here I was pulling into the staff parking lot of a funky old private sanitarium in the middle of stinking nowhere. I rang the bell and the creaky door swung open. A very pale and dusty nurse pointed to the staff lounge, but said nothing, though I seemed to detect the ghost of a smile.

A tick's tale

People have always been fascinated by medical comedies, medical dramas and medical reality shows. One of the most interesting of the current crop has to be "House, M.D." -- not because it is the most believable, but because it is by far the most inaccurate.

Hooked on mnemonics

Memory is elusive (and of course, it "lights the corners of my mind" -- or at least Barbra Streisand's mind). That's why there are so many tricks to remembering things, like acronyms, acrostics, rhyming keys, the image-name technique and the keyword method.

A leap forward

Life was fairly dull on Ganymede-13. I sat in my small bungalow on the edge of a vast forest of genetically engineered bamboo, looking at several foot-long segments of the plant.

Lunch with Lynch

Lunch with a former residency director leads to reflections on a career in medicine.

A very brief history of credentialing

While many may think of it as a modern concept, credentialing has been a part of physicians' careers since long before the Middle Ages.

Colombia, the new kid on the hospital medicine block

Hospitalists continue to gain exposure and acceptance in the U.S. as well as in other parts of the world, including Australia, Europe and Brazil. We are very excited that now the vibrant Andean country of Colombia is jumping on board.

Work hour limits: No gain without pain

Nobody would want their child riding on an icy road at 70 miles per hour in a school bus driven by someone whose head keeps nodding. Similarly, who would want to be cared for by a physician who is so fatigued he can’t remember the difference between the cranium and the cremaster?

Safety versus dignity: A balancing act

In the hospital, privacy is a scarce commodity often sacrificed in return for patient safety or our own convenience.

Just for the record

A computer crash prompts reflection on EHRs.

The final page

Medical editor Jamie S. Newman, FACP, remembers his first pager, and his next, and then wearing three at once....

The hospitalized hospitalist

Jamie S. Newman, FACP, recalls (somewhat fuzzily) his hip transplant.

The House of God revisited

Jamie S. Newman, FACP, offers a hospitalist’s perspective on a classic book.