Esta semana troquei algumas mensagens com conhecido de alguns eventos da SHM: Zubin Damania, hospitalista responsável por http://zdoggmd.com/ - doctors mashing medicine, music, and madness to educate and entertain. Clinically proven to be slightly funnier than placebo!
Conversamos sobre as diferentes visões de mundo que têm travado um pouco o movimento no Brasil.
"I believe that 1 hospitalist OR 1 traditional internist OR 1 subspecialist should captain the ship and THIS IS IMPORTANT. It allows for a consistent message to the patient, a consistent style/substance to the care, prevention of duplication, and, in the case of a hospitalist, allows for an "expert" in hospital care to manage and shepherd the patient through the system that this physician understands better than any outside doctor could".
Comentei sobre a tendência aqui de ter progressivamente mais médicos envolvidos com gestão, qualidade e burocracia, mas não enquanto coordenam o cuidado de pacientes hospitalizados, tal como os hospitalistas norte-americanos. "In our system, we have doctors that see mostly patients but also sit on committees that drive hospital protocols, quality improvement, etc. Very few doctors do just one or the other here".
Em certo momento, ele sugeriu diretrizes em relação a quando clínicos podem e devem dizer não:
"When patient safety is at stake. Our group finds itself saying "No" a lot more often than we say "yes". There are so many forces pushing us to do more, see every surgical patient, see every OB.Gyn inpatient, etc. But many of these things are out of the scope of practice for an internist and we consider them to be either unnecessary, unsafe, or both".
Does hospitalist satisfaction matter to reach the results that US Best Hospitals reach through HM programs?
"Hospitalist satisfaction is a crucial component of creating a sustainable program that is associated with long time doctors who have experience in the system and can work to improve hospital processes and administration. The programs must be designed and evolve so as to minimize burnout for doctors and maximize sustainability.
We have a lot of the same problems. They vary widely according to hospital, geography, academic versus community (or hybrid) settings. To some extent we are working thought the same issues, just maybe we are a little further along. Hospital medicine has had a little more time to mature here".