A Doctor's 100 Pet Peeves About Hospital Medicine (50-1)

A rundown of 100 behaviors, management approaches, or systems issues that frustrate me as a hospitalist (i.e. a doctor who specializes in the care of the hospitalized patient), ranked according to how frustrating they are, how dangerous they are, how common they are, and how easy they would be to fix.

The unbelievable awfulness of ABIM's MOC program:

[Plinktitioner]

I have to say, I’ve referenced your videos, dozens of times to students, new learners, new, PA, med, students, and literally anyone who will listen. Thanks for the comments

[elizabethdean]

Cooling blankets! That are grossly uncomfortable for patients and there is little to poor evidence to support the use. With some evidence indicating patients temps go up more from shivering. Hopefully they are almost never used now! They were part of protocols coast to coast even though they were NOT evidence based. Thanks for making our minds stronger Strong! Strong work!!

[mehmetvural]

Eric you are truly genuine, generous, kind, caring, outstandingly skeptical, gem of a person and very smart teacher. Kuddos to Strong Medicine. You became my idol for teaching medicine. I met with your channel when I was intern in Uptown, Chicago right before pandemic had started, now I am being academic hospitalist in Stockton, California hospital, I am still learning from your excellent courses and humbling hearing your stories. I hope I can meet with you and get to know you in person to chat on history of medicine, medical education or general medicine culture at Stanford Campus on day.

[MrZiganik]

Yeah, thanks for important words about the board!

[JonathanCirillo]

Could you please post a PDF of 100–1 for reference? I've been talking about these videos on the wards since they came out.

[uEffects]

Top 1 might lead me as a medical student to actually leave medicine all together, it's not even the fact that it's a mess, the heartbreaking thing is if you try to do it right and focus on what's important and true you're instantly forced to copy paste shit you don't have time to check and fill in boilerplate text no one needs - this takes up the time and mental capacity to actually learn, reflect and providing good care. The insanity becomes evident if you rotate through departments and see the confusion this leads to for the team trying to decipher all this mess, while doing the same with their documents.

[bethjaena]

Thank you Dr Strong, this was very helpful. Would you mind sharing a video about making good notes, whether it be in patient/out patient soap notes, discharge summary etc. Thank you again.

[deepdark]

Hi Dr. Strong,

What a wonderful list of things that you’ve shared. If I may, I had a question about #17, the Pet Peeve about hemoglobin transfusion thresholds in CAD vs ACS.

In your opinion, what are the recommended thresholds? I understand that somebody with ACS should probably get a higher threshold but I also vaguely recall reading that CAD patients (stable ischemic disease/chronic coronary syndrome) would also benefit from a slightly higher threshold than 7.

Would appreciate it greatly if you could share your thoughts on this.

Thank you!

[khaleda]

The patient notes are somewhat like a message for the next physician

I think it should be;

-a brief note with the relevant facts with a reasonable amount of background info; followed by an appendix with the long details for those who wants them;



What i see is that some people like making
--- a "mystery novel" note with so so many details and 0
10% impression on what they are looking for + 0% guide for the next guy who will see the notes on the future

Or
--a long note with so little HPI info; but is rather filled with lap results, pathology/radiology reports etc...


Thank you

[fevre_dream]

I'm not a doc, so correct me if I'm wrong: don't you start running into problems with antibiotic resistant organisms at some point with #28? Like, you may be only 10% sure of a particular infection, but if they _do_ end up having the infection and you don't give them the full course of Abx it's an issue, right? So wouldn't it end up being an all-or-nothing sort of thing?

[Fastfingers]

4:34 if the patient is not in severe dyspnea, does the exact respiratory rate (say ranging from 16-20 bpm) become significant enough to warrant a “7” on the detrimental score?

[hvymtal]

If I had to pick a couple, here are two from the weewoo realm, both with regards to interacting with hospital clinicians
1. When specialists are called to the ED for an ambulance arrival and completely ignore the EMTs/Paramedics after initial handoff. Bonus points if they ignore us completely. 8/8/5/10 on your scale. We may have information that we didn't convey in the handoff for whatever reason but can recall when asked, and it can often be significant enough to make the difference between starting with the correct course of treatment, or a longer-than-necessary stay with treatment plans being changed midway. It's certainly not an every day thing, but it happens enough that sometimes I wonder if doctors think there is some rule that means only intensivists and EPs can talk to EMS

2. Any time a medical professional refers to EMTs and especially Paramedics as "ambulance drivers, " 10/3/4/10. This usually is more of a problem with non-emergency physicians than nurses or techs of any specialty, and kind of goes hand in hand with 1. This has much potential to be harmful, because it can lead to said person internalizing the idea that EMS is just a transport service, and thus unconsciously disregard our assessment, working Dx, and Tx out of hand. It also helps blind doctors to the utility of EMS in public health initiatives. If I were to die on a hill, it would be this one

Me and my colleagues will be referred to by our proper titles, period.

[michaelhongng]

Unnecessary use of oxygen: very true- communicating with nursing staff is key. They might assume the patient accidentally took it off and replace it without checking their sat.

[hvymtal]

One of the best clinical lessons i ever learned was during rides for my first job, a wisened sage of a paramedic gave me this:

If they're symptomatic, they're symptomatic, and if they're not, they're not, unless there is a related problem. (Usually with "related" repeated for emphasis)

And yes, number 1 is a huge problem prehospital, too, at least among ET3 participants. Once treat-in-place becomes law, it will almost certainly get worse 😰

[HealeRx]

EMR's are now more or less, an accounting device. Sad.

[AliDarawshe]

Thanks doc! Interesting insight.
Timestamp 21:33 i think you meant dopamine and metoclopramide and not metoprolol :).

[piotr]

What a great unexpected ending. What have we become.

[juliachambers]

Charting “ rounded with the nurse” when in fact that didn’t happen or not happened at all. Passing the buck from specialty to specialty. Not updated notes. Cardiology saying pt in NSR when I’m fact they are in AFib.😊tons of other not so wonderful things. Nurses are backbone in my opinion.

[rajgonsai]

Awesome Topic 😂 thank you for what you do Dr Strong 🙏 You are Inspiration for younger doctors 😊

[HealeRx]

Patient presents with sickle cell crisis: do not mention race in HPI? Ok.Right.