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D epartment


M edicine

Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine

Vol. 4, Issue 4: Oct. 2015

Highlight on the Critical Care Medicine Team by Dr. Niva Misra The Medical ICU is the unit in the hospital where some of the sickest patients stay. The course of the patients’ stay may be uncertain at times. However, thanks to the critical care attending physicians, no patient goes without having the best and most dedicated care possible. These attendings not only care for the sickest of the sick but take time out of their day to teach residents how to be the best they can possibly be. Daily rounds in the medical critical care unit are very comprehensive. The attendings listen to the presentations of the residents and what interventions have thus far taken place. They help the residents think about what has been done and then educate them in treatments to consider. These physicians help teach the residents early in their careers how to value the nursing staff in the ICU and involve pharmacists and respiratory therapists for complete care of the patient. Although a very ill patient may be in the room next to the team, these attendings somehow manage to care for the patient while instructing residents in a kind and enduring way. These attendings are also some of the best physicians when it comes to speaking with families. They are truly compassionate and treat families as if they are their own. Their emotions may be so strong that they are brought to tears. In the most delicate of social situations, our attendings exhibit class, patience, and understanding. Through all of their training and stress, these physicians have not lost the empathy that we in the medical field should all exemplify.

To further show the dedication and hard work of our attendings, the pulmonary department was ranked nationally in the US New and World Report. This report is an objective evaluation of hospitals and has recognized the critical care team as outstanding. Education is clearly important to this team. The attendings are now dedicating their time to expanding the pulmonary fellowship to become a pulmonary/critical care fellowship. This would bring in more fellows to give better care to patients, assist in teaching residents, and expand the institution’s continued on page 2 research on medical critical care.

Points of View

Recent meetings have helped me to gain valuable insights into the changes in our health care system. First, there is increasing emphasis on integrating care for patients after discharge from the hospital, whether at home, in post-acute care settings, nursing homes, skilled nursing facilities, or in palliative or hospice care Rajiv Dhand, MD, Chair settings. These measures are aimed at providing a seamless transition of care for patients, with better communication between various providers, to reduce the frequency of hospital readmissions. Second, the provision of effective and more efficient care has been the focus of “patient-centered” care for several years, but 1

the Affordable Care Act has added the objective of reducing the costs of health care. There are formidable challenges in simultaneously achieving all these goals. To meet these challenges, greater standardization of care by adopting clinical pathways and minimizing waste due to unnecessary care, inefficiently delivered care, and administrative inefficiencies in insurance paperwork and electronic documentation are needed. Moreover, there is a shift from “volume-based” care, where providers are paid on a “fee-for-service” basis to “valuebased” care, which assesses the performance of care providers based on outcomes and cost. This redesign engenders a conceptual shift from treating “illness” to promoting “wellness” among the population. Thus, the quality of care will not be assessed by the number of interventions or the number of doctor or hospital visits. Instead, quality of health care delivery will be assessed at a system level by whether desired outcomes are achieved and at what cost. continued on page 3

In Touch Newsletter - October 2015  

A quarterly newsletter for the Department of Medicine at the University of Tennessee Graduate School of Medicine.

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