JAMA internal medicine
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Widespread burnout among physicians has been recognized for more than 2 decades. Extensive evidence indicates that physician burnout has important personal and professional consequences. ⋯ Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return on investment measurable. Addressing this issue is not only the organization's ethical responsibility, it is also the fiscally responsible one.
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JAMA internal medicine · Dec 2017
ReviewThe Practice and Implications of Finding Fluid During Point-of-Care Ultrasonography: A Review.
Point-of-care ultrasonography (POCUS) is an increasingly affordable and portable technology that is an important part of 21st-century medicine. When appropriately used, POCUS has the potential to expedite diagnosis and improve procedural success and safety. POCUS is now being adopted in medical education as early as the first year of medical school. While potentially powerful and versatile, POCUS is a user-dependent technology that has not been formalized or standardized yet within internal medicine residency training programs. Physicians and residency directors are trying to determine whether to incorporate POCUS, and if so, how. In this systematic review, basic concepts and applications of POCUS are examined, as are issues surrounding training and implementation. ⋯ POCUS can augment physical examination and procedural efficacy but requires appropriate education and program setup. As POCUS continues to spread, internal medicine physicians need to clarify how they intend to use this technology. Equipment is now increasingly accessible, but programs need to determine how to allocate time and resources to training, clinical use, and quality assurance. Programs that develop robust implementation processes that establish proper scope of practice and include quality assurance that use image archival and feedback can ensure POCUS will positively impact patient care across hospital systems.
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JAMA internal medicine · Dec 2017
Comparative StudyComparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists.
A physician's prior experience caring for a patient may be associated with patient outcomes and care patterns during and after hospitalization. ⋯ A PCP's prior experience with a patient may be associated with inpatient use of resources and patient outcomes. Patients cared for by their own PCP had slightly longer lengths of stay and were more likely to be discharged home but also were less likely to die within 30 days compared with those cared for by hospitalists or other generalists.