CAREER GUIDE for RESIDENTS Featuring: • Authorization to treat and other quagmires • Helping hands come from the community • How to be successful at early discharges • Increasing nutrition education in medicine • Document to defeat malpractice suits • How doctors can be social media ’Influencers’ Winter 2020 | acponline.org/careers AD9005 AD9005 Winter Career Guide 2020_FRONT.indd 1 2/13/20 9:34 AM APage Template_Apage template 1/21/2020 12:41 PM Page 1 DOLLY ABRAHAM, MD, MBA, SFHM HOSPITAL MEDICINE !01.! ƫ+10$!.*ƫ,,+.01*%0%!/ ƫ ƫƫ ƫ ! %(ƫ%.!0+.ƫ* ƫ+/,%0(%/0 !*+*Čƫ ƫ ƫ ƫƫ ! %(ƫ%.!0+. .! !.%'/1.#Čƫ ƫ ƫƫ ƫƫ ! %(ƫ%.!0+. %)%Čƫ ƫ ƫ ƫƫƫƫƫƫƫƫƫƫƫƫ ! %(ƫ%.!0+. +.0/)+10$Čƫ ƫ ƫ ƫƫ +/,%0(%/0 !.%*#Čƫ '!ƫ%05Čƫ 0ċƫ(0+*ƫ!$Čƫƫ /$2%((!Čƫ .! !.%'/1.#Čƫ ĉĈĈċĂćĆċćĉćĊƫƫ *,0%!*0 +/Į*2%/%+*!(0$ċ+) AD9005 Winter Career Guide 2020_FRONT.indd 2 2/13/20 9:34 AM 2020 Winter Career Guide for Residents Table of Contents Articles Authorization to treat and other quagmires .......................................................................... 2 By Margo Williams, MHA,CMPE How to be successful at early discharges ............................................................................... 3 By Kashif J. Piracha, MBBS, FACP Document to defeat malpractice suits .................................................................................... 4 By Stacey Butterfield Helping hands come from the community ............................................................................. 6 By Charlotte Huff Increasing nutrition education in medicine ............................................................................ 9 By Mollie Frost How doctors can be social media ’Influencers’ ................................................................... 11 By Mollie Frost Classifieds Annals of Internal Medicine Display....................................................................................... 13 Annals of Internal Medicine Non-Display .............................................................................. 17 ACP Hospitalist .......................................................................................................................... 18 ACP Internist .............................................................................................................................. 22 2020 Winter Career Guide for Residents Annals of Internal Medicine, February 18, 2020 • ACP Hospitalist and ACP Internist, February 2020 ACP CONTACT INFORMATION ADVERTISING SALES Vera Bensch • 215-351-2630 (Phone) • 215-351-2641 (Fax) • [email protected] Maria Fitzgerald • 215-351-2667 (Phone) • 215-351-2738 (Fax) • [email protected] Ryan Magee • 215-351-2623 (Phone) • 215-351-2685 (Fax) • [email protected] ADVERTISING SUPPORT Paula Bayard • 215-351-2671 (Phone) • 215-351-2738 (Fax) • [email protected] GENERAL INFORMATION • 800-523-1546 or 215-351-2400 • 215-351-2738 (Fax) 2020 Winter | Career Guide for Residents 1 AD9005 Winter Career Guide 2020_FRONT.indd 1 2/13/20 9:34 AM Authorization to treat and other quagmires Authorization for medical decision making regarding end-of-life planning is something that patients need to consider both at the beginning of adulthood and in the later years of life. By Margo Williams, MHA, CMPE When a patient is unable to make sound decisions about her own care, what is the physician practice to do? It could be an elderly patient whose cognitive abilities are declining, or a college student who is over 18 but has never dealt with medical care on his own before, or a seriously ill patient who is planning for the future. It is important for the practice to have someone to communi- cate with about such patients without fear of violating HIPAA or state laws. Authorization for medical decision mak- ing is something that patients need to con- sider both at the beginning of adulthood and in the later years of life. Although young adult patients may not need the same level of thought regarding end-of-life planning, it is important to educate them about HIPAA privacy and security rules. Young adults often incorrectly assume that their parents or significant others will have automatic access to their information and can and will make decisions on their behalf in case of emergencies, so it is important to ask them specifically and proactively about who is allowed to communicate with members of be used together with the other documents when a patient the care team if and when needed. This can easily be accom- cannot make treatment decisions. For older patients, advance plished by including one or more forms along with new-pa- care planning is an important discussion to have at least once tient paperwork. and to likely revisit as things change. For older patients, or patients with serious or terminal The practice should establish a policy that staff and clini- conditions, it is even more important to address what they cians can follow regarding when and how to discuss advance want and who is authorized to make decisions on their behalf. care planning. You can start by contacting your malpractice Clinicians may conduct (and bill Medicare for) advance care carrier to see if they have any examples you can use. Because planning as needed (typically at the time of a health status rules can vary by state, your state or local medical society may change or other significant life change, such as marriage, have policies that provide state-specific information. ACP’s divorce, or event that might affect whom a patient may wish to educate or designate). Advance Care Planning Toolkit provides resources to explain Practices can be prepared for these scenarios with a little and bill for advance care planning and to access forms that planning. Clinicians and staff should know about several doc- you might need to provide your patients. The HIPAA Privacy uments. The living will or advance directive provides general Manual includes authorization forms that patients can use to guidance about what treatment a patient would or would not authorize specific individuals to have access to their informa- want, but it is not a medical order, so clinicians cannot use it to tion. The Patient Education and Caring: End of Life (PEACE) guide treatment decisions. The power of attorney (sometimes Series also provides guidance. n called a medical power of attorney, medical proxy, or health Margo Williams, MHA, CMPE, is Manager of Practice Support care agent, depending on the state) designates a specific indi- for ACP’s Department of Medical Practice, which provides mem- vidual to make decisions for a person when and if he is unable bers with resources related to practice management, regulatory to make his own decisions. The physician orders for life-sus- compliance, and health information technology. taining treatment (or physician orders for scope of treatment) form is generally used to detail treatment wishes of patients From the October ACP Internist, copyright © 2019 who are nearing the end of life. This last document would by the American College of Physicians 2 2020 Winter | Career Guide for Residents AD9005 Winter Career Guide 2020_FRONT.indd 2 2/13/20 9:34 AM How to be successful at early discharges A hospitalist offers tips on planning and working ahead. By Kashif J. Piracha, MBBS, FACP Somebody once said that more than half the battle is won a lack of transportation on the day of discharge. Most times, with good preparation. This certainly applies to early dis- patients depend on a relative or a loved one to come pick charges, which are very important to most hospitals and many them up from the hospital. If the hospitalist waits to inform the patients. Hospitalists are at the forefront of all early-discharge patient about his discharge until the actual day it’s happening, efforts. Since I am a hospitalist myself, this is something that I his ride may not be available until after 5 p.m., when most deal with daily. I have come up with some strategies to make people get off work. Transportation issues must be worked out myself more efficient in my practice, and I think other hospital- with the patient the day before discharge if an early discharge ists might benefit from these strategies too. is to be successful. Things to do at admission Things to do the day of discharge The foundation of any discharge can be laid as early as the The first thing to do on the day of discharge is to look over day of admission. Many times, even then, the hospitalist has all the morning labs and imaging results to make sure they a rough idea about some aspects of a successful discharge. are satisfactory. Next, the hospitalist must talk to the patient’s One of the most common examples of this is the discharge nurse to inquire about any important overnight events that destination. Depending upon the could have a bearing on discharge, such physical abilities of the patient and as a rapid response or deterioration in the circumstances of the case, one can the patient’s condition. Next, if a place- estimate whether the patient will be ment is planned, the hospitalist should able to go back home or will require communicate with the case manager to placement in a facility for rehabilitation make sure insurance approval has been or continued medical care. If the latter obtained. By this time, the hospitalist is the case, case management consul- should have already obtained clear- tation should be sought immediately. ance from the consultants on the case Also, physical and occupational therapy and the patient’s transportation should consultations