SPEAK SOFTLY AND CARRY A BIG STETHOSCOPE: MY FIRST SHM CONFERENCE
Amazing. Inspiring. Educational. Adjectives upon adjectives would not be enough to describe my experience at the Society of Hospital Medicine’s Annual Conference in National Harbor, MD. From the gorgeous venue to networking with exceptional hospitalists, I thought I was in internal medicine heaven. I wanted to take some time to reflect upon the sessions that I really enjoyed.
My first lecture by Dr. Tony Breu from the Veterans Affairs at Boston, ‘Things We Do for No Reason,’ was all about high-value care, a topic at times missed in the busy resident schedule. For example, he mentioned we often get stress tests for patients admitted with low-risk chest pain the next morning. The data illustrates that these stress tests do not add any value! Furthermore, the jury may still be out when we put all our patients on chemoprophylaxis with subcutaneous heparin or enoxaparin. However, in low-risk thromboembolism patients, we can avoid increased bleeding risks by avoiding their use – not only saving money for our patients, but from potential harm as well.
Another session that truly hit home as a resident- was about clinician burnout, presented at the second day keynote by Dr. Tait Shanafelt. His thought-provoking lecture looked at the definition of burnout and how there are so many factors driving clinician distress. Seeing the lecture hall bursting with residents, students, and attendings helped me realize that I wasn’t the only person bogged down by writing patient notes when I’d rather be interacting with the patient, or questioning my career choice while on call. The potential solutions he discussed placed hope in the future of medicine by increasing value in our work and emphasizing personal wellness.
I truly enjoyed the Rapid Fire sessions. As a rising attending, the session about ‘Can I Go Home? Who is Safe for Discharge,’ provided me the knowledge-base to feel more comfortable about properly sending patients home. Oftentimes, on the morning of a planned discharge, the nurse may call to say the patient is tachycardic or with elevated blood pressure, and I personally freeze worried if the patient is tuned-up for discharge. However, the emphasis should be on the patient as a whole. For instance, with elevated blood pressure, we tend to inundate patients with IV anti-hypertensives. However, the important aspects in management is to rule-out end organ damage, look for common causes i.e. pain, allow rest, and to coordinate close follow-up upon discharge. And of course, we always hear our patients say they’re not ready to go home. The speaker encouraged us to help the patient understand their recovery plan and assure they have social support at home in order to overcome these barriers to discharge.
In the ‘Whirlwind Tour’ of landmark cases by Drs Dennis Chang and Daniel Ricotta. From the 2015 NEJM study about hi-flow oxygen helping to reduce mortality in hypoxic patients to community-acquired pneumonia antibiotic duration, the lecture helped to remind us of why we do the things we do in practice as residents daily. I learned about the JAMA study in 2013, where it was found that salt and fluid-restricted patients do no better than normal-meal CHF exacerbation patients. I can finally help my patients feel less tortured in the hospital besides getting stuck with IVs and blood drawn during midnight. It was all an amazing reminder of the importance of evidence-based medicine.
However, my favorite part of the conference by far was when I was able to present my posters during the clinical vignette poster competition. Learning about super-interesting cases from hundreds of other residents and attendings was the highlight of the conference. Meeting people from across the world and sharing memorable stories about our patients, and networking with inspirational physicians during the vignettes was truly wonderful.
Sessions upon sessions, updates upon updates, and innovations upon innovations-- the SHM conference exceeded my expectations. What blew my mind was the mobile app that provided not only the agenda of the conference, but a photo scavenger hunt, and even the ability to download content to review at our own leisure.
Amidst the flowering cherry blossoms, in such proximity where great leaders like Dr King and President Lincoln walked the same paths, the SHM conference was a beautiful respite from the life of residency. As a hospitalist-in-training, the conference was an eye-opening experience about the incredible accomplishments of hospitalists throughout the country. Although it was my first time at this conference, I know it will not be my last!