The palliative care community supports advance directives as a way of empowering patients to take charge of their health and treatment, but partial do-not-resuscitate orders are a different matter. Experts report that, by allowing patients to pick and choose treatment options, they can lead to care that is clinically infeasible and ethically questionable. Worse, partial DNRs can signal that physicians failed to communicate with patients in a timely and thorough way about how their treatment choices might play out. Our cover story explores some of the barriers and problems with partial DNRs, what to do when faced with one, and how to ensure patients' advance directives truly reflect the kind of care they desire.
The ACP Hospitalist staff was on hand to cover the news and issues germane to hospitalists at ACP's annual meeting, Internal Medicine 2011, held in San Diego in April. Our special coverage of the meeting starts with a look at the latest bugs and drugs seen and used in the hospital setting. The story runs through the bacteria and strains currently posing the greatest threat in hospitals, how the newer drugs respond, and how old drugs can be used in fresh ways to tackle stubborn infections. Our meeting coverage continues with two stories about care in the ICU, one on evaluating elevated body temperatures, the other on the best use of diagnostic testing. A recap of the “Life after Residency” session explores the factors hospitalists should consider when looking for their first job, while another article discusses some of the acute dermatological problems hospitalists might encounter in their work. Finally, an article on delirium provides a taste of the meeting's first hospital medicine precourse—one of the most well-attended precourses in ACP history.
Also in this issue, coding columnist Richard Pinson, FACP, explains how to use newly instated codes for longer-stay observation care, while our Success Story looks at how to reduce length of stay among observation patients altogether. Guest columnist Peter Ubel, ACP Member, writes in our new Perspectives section about how hospital protocol needs to be changed to ensure patient sleep is a priority. Finally, don't forget to nominate a colleague for our fourth annual Top Hospitalists issue by visiting our online form.
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Editor, ACP Hospitalist