Would Sir William Osler Have Made His RVUs?

Health systems strive to reflect physician value in compensation plans.  However, we all know that patient care volume rules, as measured by Relative Value Units (RVUs).

A cheeky perspective on the matter is published in Annals of Internal Medicine, full text available here.

Sir William Osler almost certainly would not have met his RVUs. His value was in that of a teacher, educator, investigator and scholar. Patient care was not unimportant and served as the basis of his writings and teachings.

Greatness comes from contributions to healing and to the craft of medicine, not from the generation of RVUs. 

The Great Alone by Tim Voors: Recounting an Epic Journey on the Pacific Crest Trail

I am off topic again, this time to share a recent book that I read. 

The Great Alone, by Dutchman Tim Voors, is an account of one man's solo walk across the entire Pacific Crest Trail. Voors battled, heat, wind, cold, thirst and intense isolation over the 2600+ mile trek. An inward look on an outward trail.

The book is also a visual feast with stunning photographs. 

I cannot help but envy Voors' courage and determination to escape the hyper-connectedness and over packed schedules of this day and age, albeit non-permanently. 

 To experience growth and overcome fear, look inward and seek a great alone.

University of Virginia-Virginia Commonwealth University 2019 ID Case Conference

Kudos to to our colleagues at the University of Virginia, including my ID Division Chair counterpart Dr. Eric Houpt, for a very successful, combined and highly interactive infectious diseases case conference, done today by telelink.

A special thank you to our clinical infectious diseases fellows, Dr. Nicole Vissicheli (VCU) and Dr. Bree Campbell (UVA) for their respective cases on HTLV1 myelopathy and Capnocytophagia canimorsus sepsis. Of course, none of this could have happened without our excellent staff who coordinated it all.

These events serve both to teach and to remind us of the value of academic collaboration.

I am already looking forward to the next combined ID conference between our institutions in 2020.

Perioperative Disposable Jackets for SSI Reduction: An Untested Hypothesis Tested

Kudos to Erik Stapleton et al for assessing  the association of disposable perioperative jackets  with surgical site infections. The study was performed in a large multi-center health care organization. This paper was recently published in JAMA Surgery. An untested hypothesis tested.

The AORN recommends mandatory adoption of disposable perioperative jackets for surgical site infection reduction. This trial with multi-variable analysis concluded that disposable perioperative jackets are not associated with surgical site infections in clean operative procedures. The finding is not surprising as most surgical site infections originate from the patient's own endogenous flora and not external factors.

Mandating an intervention based on little to no evidence is fraught with peril and subject to provider backlash.This is precisely why our policy of bare below the elbows (BBE) is an infection prevention recommendation and not a mandate. BBE is simple, safe, and cheap, unlike the wasteful and expensive disposable perioperative jackets. Over time, BBE transformed into normative behavior at VCU health, as published here.

As for mandatory disposable perioperative jackets, it may be time for a strategy reconsideration.

A Wandering Mind is an Unhappy Mind: Proven!

I came across this article (full text) in Science titled A Wandering Mind Is an Unhappy Mind.

The authors developed a web application for the iPhone to create a large database of real-time reports of thoughts, feelings and actions. The volume of data was impressive with a quarter of a million samples from approximately 5000 people, across 83 different countries.

Mind wandering is frequent, in greater than 46% of the cohort. Participants self reported less happiness when their minds were wandering. People were no happier when thinking about pleasant topics.

To quote the authors: A human mind is a wandering mind, and a wandering mind is and not happy mind.  The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.

We train our bodies for greater fitness yet commonly neglect to train our minds for greater focus. Let your mind wander and think of what we could achieve with greater attention.

Thank You Colgate University: 2019 Wolk Conference on Medical Education and Men's Soccer Alumni Reunion Weekend

Thank you Colgate University for the honor of presenting at the 2019 Michael J. Wolk Conference on Medical Education.

It was an absolute pleasure to be back on campus and to meet so many talented students. The alumni guests, all working in healthcare, were impressive and inspirational. What a delight.

Also, thank you to Colgate Men's Soccer Coach Erik Ronning, for hosting the soccer alumni reunion. I survived the men's soccer alumni game, managed to play well (enough) and not get injured.

Saturday afternoon was spent watching NCAA Division I soccer: Colgate vs Loyola.

Later, a stroll around the campus.

Memories, friendships and shared experiences, both in the classroom and on the soccer pitch. 

Colgate vs Loyola 

Colgate vs Loyola

Colgate vs Loyola

1992 Patriot League Championship Trophy- Senior Year Honor

Alumni Game: Sporting the 2019 Colgate University Goalkeeper Jersey

Happy Global Handwashing Day!

Dr. Ignaz Semmelweis

Just in case you were not in the know, today is Global Handwashing Day! Make it a safe and clean one!

See the dedicated Global Handwashing Day website, here.

Ignaz Semmelweis would be proud. 

Beware of Presenteeism: Respiratory Viral Season is Around the Corner

Beware of presenteeism. Respiratory viral season is just around the corner.   

Kudos to Priya Nori and colleagues on this publication on presenteeism (working when sick) in training programs, a relevant reminder of the looming threat of viral respiratory pathogens transmitted within the workplace.

Presenteeism is high amongst training programs.  Aggressive campaigns are needed to raise awareness about the danger to patients from ill providers.  

A culture shift is required to emphasize 'fitness for work' rather than being a 'hero'  when working under the weather.

The time for action is now, at the onset of viral respiratory season in North America.

Thank you Richmond Academy of Medicine: Lunch on Tuesdays Program and Infection Prevention

Thank you to the Richmond Academy Medicine for their invitation to speak today at the Lunch on Tuesdays Program.

Not surprisingly, my topic was the only thing that I know a little bit about, hospital infection prevention.  The lecture was largely based on our published manuscript titled Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try. The paper is accessible via PubMed, here.

It was a pleasure to give a lecture locally with such an engaged audience.

ID Week 2019, Washington DC: Day 4- Parting Shots

Really enjoyed ID Week 2019. High quality meeting with meaningful colleague interactions. That's what it is all about.

Kudos to all the high quality presentations during the session that I moderated with Dr. Shandra Day.

Wonderful ID Week Leadership reception at the Smithsonian Museum, where I visited the infectious diseases outbreak exhibit, to round out the experience.

Heading back to Richmond later in the afternoon, already looking forward to ID Week 2020.

ID Week 2019, Washington DC: Day 3- SHEA Society Awards

Thank you to the Society for Healthcare Epidemiology of America (SHEA)for the 2019 Barry Farr Award for the best domestic clinical study published in Infection Control and Hospital Epidemiology (ICHE). Our manuscript is PubMed Indexed here.

More importantly, thank you to my amazing collaborators and to all of the healthcare workers at VCU. They do all the work so that I may take the credit.

Last, it was an honor to share the awards ceremony with Dr. Joseph Mylotte, the 2019 Recipient of he Sue Bradley Award, for his work as an ICHE manuscript reviewer. Dr. Mylotte made a huge and positive impression on me during my time as a medical student at the University of Buffalo.

I am humbled by the high quality colleagues honored today at the ID Week 2019 SHEA Society Awards.

Preventing C. difficile in the Hospital: What is the Endgame? Latest Publication in BMJ Quality and Safety

What is the endgame in preventing C. difficile in the hospital?

Our perspective on the matter, with Susy Hota as the first author, is now published in BMJ Quality and Safety. The article is accessible here.

Prevention requires bold and calculated steps to minimize the overuse of antibiotics in the hospital. All other strategies are minimally effective. 

ID Week 2019, Washington DC: Day 2

The Three Amigos Reunited: with Drs. Mike Edmond (University of Iowa) and Mike Stevens (VCU)

ID Week 2019 is off to a roaring start. The high quality scientific program serves both to educate and inspire.

Perhaps the real reason for why I consistently attend these meetings is to catch up with colleagues, mentors and friends. 

Nearly all my accomplishments in academic medicine is from collaboration with high quality colleagues.

Thank You Society for Healthcare Epidemiology of America (SHEA) Board of Trustees ! It Has Been Great.

Thank you to the Society for Healthcare Epidemiology of America (SHEA) Board of Trustees for two really great years on the board. My term concludes at the end of the year and this ID Week conference marks my last in person board meeting.

More importantly, thank you to SHEA for all that it does to advance patient safety and the science, education and implementation of healthcare epidemiology.

Last, thank you to the entire SHEA Board and staff, your work is truly inspirational. 

As always, I have learned much more than I have contributed.

It was an honor.