Facing tough decisions

This month, we look at SNF vs. home care after hospitalization, care for migrants, and physician suicide prevention, among other issues.

This issue looks at some tough decisions for physicians. Our main story focuses on inpatients who could be discharged to either a skilled nursing facility or home care. The potential consequences of this choice include patient outcomes and health care costs, so the article covers both the challenges and some tools and strategies for finding the most suitable postdischarge care.

For Scott A. Allen, MD, FACP, the difficult decision was whether to become a whistleblower regarding the problems he had observed at government detention facilities on the U.S. border with Mexico. In this month's Q&A, he talks about how he and a psychiatrist colleague brought the U.S. Senate's attention to harm being inflicted on detained children. He challenges us all to follow his lead in pressing the government to abandon its “zero tolerance” policy with the harms that inevitably result.

Continuing the focus on the border, a feature article in this issue describes physicians' efforts in New Mexico to offer care for people who have just crossed into the state or have been dropped off there by government officials. Public officials, physician volunteers, and academic medicine leaders explain how they provide “travel triage” and try to rapidly meet these patients' most basic medical needs.

Don't focus too hard on the needs of patients that you forget your own and those of your colleagues, though. National Physician Suicide Awareness Day is on Sept. 17, and we're marking it with a Perspectives piece on how one hospitalist's personal losses have inspired her to try to prevent future ones.

That's a lot of heavy topics, so you might want to turn to Newman's Notions for advice on lightening your mood. If it works, you should let us know at acphospitalist@acponline.org.

Stacey Butterfield