IT Controversies, Burnout Hot Topics at Hospitalists Meeting

Marcia Frellick

February 23, 2016

SAN DIEGO — Controversies surrounding the latest technology, strategies in care transitions, and battles for balance between work and home life were among the top drivers of programming here at the Society of Hospital Medicine 2016 Annual Meeting.

The explosion of technology in medicine will have a prominent place in this year's conference, said Melissa Mattison, MD, chief of the hospital medicine unit at Massachusetts General Hospital in Boston, and program coordinator for the conference. Topics will range from social media, the use of information technology in handoffs, the integration of decision support into electronic health records, and the leveraging of information technology in the shift from volume to value.

And with the increasing availability of technology comes controversy about how it should be used, she told Medscape Medical News.

"Copy and paste," or the practice of dumping lengthy notes into an electronic health record, which is leading to frustration for those who have to sort through them, will be addressed by Julie Hollberg, MD, chief medical informatics officer for Emory Healthcare in Atlanta.

Dr Hollberg will talk about the role of the hospitalist as a note creator in the electronic age. "When we worked by hand, we never pasted in the entire radiology CT scan report," she told Medscape Medical News.

Dr Hollberg will also tackle the cultural shift that has meant that hospitalists, especially the younger doctors, rely on technology to tell them about antibiotic recommendations, correct dosing, and drug–drug interactions, but often ignore alerts.

"Many sites, including ours, have an override rate above 90% on the alerts. We can't have a culture where we simultaneously avoid the alert," she explained, "and also expect the computer to prevent us from making safety errors."

Managing "open notes" in patient portals is a struggle for many doctors, who don't always know when and what information should be easily accessible to patients. Dr Hollberg will discuss how sharing notes can help patients engage in their care, and how the notes can serve as another layer of safety.

Work–Life Balance

A panel discussion on strategies for balancing a hospitalist career with home life will be highlighted in a double session, Dr Mattison reported. "It's not designed just for women or for parents, it's designed for humans," she said.

Toward the goal of sustaining personal and professional relationships over time, Steven Pantilat, MD, professor of clinical medicine and director of the palliative care program at the University of California, San Francisco, and Denah Joseph, MFT, also from the University of California, San Francisco, will share practical strategies to reduce the risk for burnout and to manage stress.

"Burnout is a serious issue for physicians, period," and because hospitalists tend to be younger and to be front-line clinicians, there's even higher risk, Dr Pantilat told Medscape Medical News.

The pair will address the signs of burnout; the impact of burnout on care, patient satisfaction, and decision-making; and the role burnout plays in the early retirement of physicians.

"In some ways, hospitalists have a lot of control, because they are not bound to a particular schedule," Dr Pantilat explained. But patient load and the severity of illness can make coping particularly difficult.

Evidence-based ways to effectively, and in a short amount of time, share concerns and practice disciplines — such as mindfulness and "appreciative inquiry," or asking colleagues what they're grateful for — will be presented.

"It's really remarkable how just that ability to focus on something positive and talk with someone who is attentively listening can make such a difference in your day," Dr Pantilat said.

There is a gap in physician training when it comes to the avoidance of burnout, Joseph told Medscape Medical News.

"It takes a great toll on people to be exposed to so much illness, suffering, loss, and death, and we're not equipping physicians to deal with the emotional burdens," she explained. "The little bit of training people get in residency is usually around sleep problems."

Twenty Years of Progress

New at the conference this year is a track on postacute care, because "many hospital medicine providers are providing care beyond the walls of the hospital," said Dr Mattison. The track will focus on building and managing a practice from inpatient to postacute settings.

And for those thinking about a hospitalist career or who are new to the specialty, the young hospitalists track, introduced last year, will focus on how to identify a mentor, how to get published, and how to stand out in an interview, Dr Mattison told Medscape Medical News.

Dr Mattison said she expects more than 3000 people to attend the meeting.

"My sense is that there will be more attendees than at any other annual meeting," for a couple of reasons, she said: the meeting is in San Diego in the winter, and the number of hospitalists grows each year. There are now roughly 50,000 hospitalists, although the term was coined just 20 years ago by Robert Wachter, MD, and Lee Goldman, MD, both from the University of California, San Francisco (N Engl J Med. 1996;335:514-517).

Again this year, Dr Wachter will close the conference with a look at where the field is headed.

Dr Mattison, Dr Pantilat, Ms Joseph, and Dr Hollberg have disclosed no relevant financial relationships.

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