JAMA internal medicine
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JAMA internal medicine · Jan 2018
ReviewVoluntarily Stopping Eating and Drinking Among Patients With Serious Advanced Illness-Clinical, Ethical, and Legal Aspects.
Patients with advanced illnesses sometimes request that physicians help hasten their death. Increasingly in North America and Europe, legal options allow physicians to perform this role. Among death-hastening options, the spotlight has been on physician-assisted death. ⋯ In this review, we examine both clinical issues in assessing patients who are considering VSED and the clinical challenges that may emerge during VSED. We also explore some of the underlying ethical and legal considerations for physicians who either care for or decline to care for these patients. Physicians who care for seriously ill patients should be prepared to respond to patients' requests to participate in VSED.
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JAMA internal medicine · Jan 2018
Patient-Sharing Networks of Physicians and Health Care Utilization and Spending Among Medicare Beneficiaries.
Physicians are embedded in informal networks in which they share patients, information, and behaviors. ⋯ Characteristics of physicians' networks and the position of physicians in the network were associated with overall spending and utilization of services for Medicare beneficiaries.
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JAMA internal medicine · Jan 2018
Multicenter Study Comparative StudyA Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions.
Robust laboratory use data are lacking to support the general assumption that teaching hospitals with trainees routinely order more laboratory tests for inpatients than do nonteaching hospitals. ⋯ Compared with nonteaching hospitals, patients in Texas admitted to major teaching hospitals with bacterial pneumonia or cellulitis received significantly more laboratory tests after controlling for illness severity, length of stay, and patient demographics. These results support the need to examine how the culture of training environments may contribute to increased use of laboratory tests.
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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.