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Notes From My Hospital Medicine Conference

Posted Oct 30 2008 11:46am

In 1997, I launched the nation's first hospital medicine continuing medical education (CME) course (that year, we had about 100 attendees, including a few homeless people who wandered into our seedy hotel to see what the fuss was about; here's a fuller history if you're interested).  Today, we finished our 11th annual meeting, now at the lovely Fairmont Hotel on Nob Hill. The course has become amazingly popular – this year we have 600 attendees from around the country. I’ll post a few more substantive observations in the coming days, but thought I’d give you some of my quick impressions:

Every year this conference makes me really glad I’m at UCSF. For the past few days, I’ve had a chance to listen to my colleagues speak about a variety of topics – strokes, sepsis, acute coronary syndromes, neurological emergencies, workup of PE, ICU safety – and they really are splendid teachers. In their talks, not only does their unbelievable expertise shine through, but so does their humanity, humility, and humor. Many of the attendees came up to me and said, “boy, you’re lucky to work with such brilliant, wonderful people.” I agree.

The course is also my chance to welcome a few former colleagues back to San Francisco. I hate it when one of my great colleagues/friends moves to another institution, but I've come to realize that there is a natural order to this. Scott Flanders could have stayed in SF waiting for me to retire, or leave to build a world-class hospitalist program at the University of Michigan. He made the right call (even though I drove him crazy by sending him daily Ann Arbor weather reports for the entire winter before he left). Kaveh Shojania also headed north, returning to his native Canada, where he holds a prestigious endowed chair and continues to do splendid work in safety, quality, and evidence-based medicine. Peter Lindenauer has not only become a key quality and safety leader at Baystate Medical Center in western Massachusetts, but has gone on to do truly seminal research on P4P and quality measurement. Seeing all of these wonderful folks succeed and “spread the gospel” is a source of great pride, and it's a joy to welcome them back to SF for the week.

I recall one of our early iterations of this course, in about 1999. I expected 100 or so registrants, but about 350 people came. Before I walked into the first session, my wife turned to me and said, “I hope you really think this hospitalist thing is a good idea.” Well, after finishing 3 days of hearing what’s new in hospital medicine, I am more convinced than ever that it is a good idea. As my brain swims with new data and insights about hospital medicine, the idea of trying to stay up on all of this while also staying abreast of the workup and management of outpatient diabetes, heart failure, osteoporosis, arthritis, and preventive strategies (one study showed that simply administering all the recommended prevention practices would take an outpatient doctor nearly 8 hours a day) seems all-but-impossible.

That said, I surveyed our audience and found that about 20% were nonhospitalists – a useful reminder that there are still many traditional internists, family physicians, and pediatricians who care for their own hospitalized patients. Whatever your opinion about the hospitalist question, one has to applaud these physicians' dedication to staying current.

People wonder about whether CME does any good, either because content taught in big lectures tends not to stick or because many CME courses are golf-laden boondoggles. It is now Saturday morning, and 90% of our registrants are still here (and they’ve already received their CME certificates and it is gorgeous day in San Francisco – lots of excuses to play hookie). I admire their commitment, and, though I can’t prove it, I think we’re saving a few lives here in the Fairmont Hotel.

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