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.