Healthcare Musings

Once again, randomized control trial data show that aggressive fluid strategies in septic shock are not harmful. Dr. Hassabolus is vindicated, yet again.  Many thanks to the PulmCCM Substack for its excellent analysis of the critical care literature: https://open.substack.com/pub/pulmccm/p/early-vasopressors-are-superior-to?r=2d9b5g&utm_medium=ios  

The things we say have an impact. The words we use actually do matter. In this episode, Dr. Hassaballa discusses the impact of changing one word in a phrase can have on the people with whom we interact. It’s part of how habit becomes ritual. 

Traditionally, the word “respect” means “high regard.” When we delve into its Latin root, however, we get a much deeper understanding. For me, it has changed my behavior.  This week’s episode is a reflection on last week’s amazing conversation with Marion Spears Karr.  Episode Link: https://www.healthcaremusings.com/taking-gratitude-from-habit-to-ritual-my-conversation-with-marion-spears-karr/

As leaders, do we thank our teams sincerely? Or is it simply a habit without any purpose or meaning?  My conversation with Marion Spears Karr, CEO of Inflow Executives and founder of the Authentic Gratitude Communication Framework (AGCF) Program, really brought home those questions to me as a leader.  Marion Spears Karr on LinkedIn: https://www.linkedin.com/in/marionspearskarr

On June 7, 2009 my eldest daughter, Bayan, died from complications of lymphoma. Ever since that day, there have been songs that have helped me deal with the grief of her loss. I call them, “The Soundtrack of my Grief.” The song I reflect on here is “Weightless,” by Natasha Bedingfield.  Song on Apple Music: https://music.apple.com/us/album/weightless-less-is-more-version/402882140?i=402882221  

Will AI replace all Doctors? How good is the medical literature? What about the hype in Medicine today? I asked these and many more questions of Dr. Bobby Dubois, and our conversation was insightful and illuminating.  Dr. Bobby's Podcast: https://drbobbylivelongandwell.com/   **Please note: There was a problem with the audio in the first third of the recording, which I tried to fix as best I could...

When I first started practicing, progress notes in the medical record said nothing because physicians did not write legibly. Now, we have multi-page progress notes that are legible and also say nothing. Why are we still here? 

This is the first in a new series of soliloquies by Dr. Hassaballa called “Dr. H’s Verbal Hassaboluses.”  And for the very first one, he advises Residents and Fellows to PLEASE stop writing system-based notes. 

While we all trained at the Academy, most of the care provided to patients occurs in the Community. And it seems that, more and more, the research output from the Academy is not clinically relevant to the Community.  So, I wanted to discuss this with Dr. Scott Matson, an Academic Clinician-Scientist at the University of Kansas. Our conversation was very enlightening.  Dr. Matson’s Substack: https:...

Six years ago, today, was the darkest day of the Covid 19 pandemic for me. And it was good for me that all my emotion came out at the time it did. 

The purpose of the healthcare system is to heal the sick, and unfortunately, it seem that the system has strayed from this purpose.  Gil Bashe, Chair of Global Health and Purpose for FINN Partners, reminds us of this purpose in his excellent book, "Healing the Sick Care System: Why People Matter."  I sat down with Gil Bashe to discuss his book on this week's episode of Healthcare Musings. It was a...

Sepsis is the number one diagnosis treated in most intensive care units across the world, and it can be very deadly in short order. Yet, is sepsis even a disease?  "No," according to Dr. Rafael Olive Leite, aka, the "Thoughtful Intensivist" on Substack.  According to him, the whole "sepsis epistemology" is flawed, and this is why he continuously rails against the Surviving Sepsis Campaign.  I have...

The healthcare system is supposed to be centered around just one person: the patient. According to Matthew Zachary, however, the healthcare system has failed miserably in its mission. Of all the voices that have been heard on this podcast, the one that hasn't been heard is that of the patient...until now.  On this week's episode, I sat down with Matthew Zachary, patient advocate and all around ama...

The 2026 Surviving Sepsis Guidelines were released last March in Chicago. Among the dozens of recommendations, there are 17 “strong” recommendations. In this episode, Dr. Hassaballa speaks about these 17 strong recommendations and its implications on clinical practice.  Surviving Sepsis Guidelines: https://sccm.org/survivingsepsiscampaign/guidelines-and-resources/surviving-sepsis-campaign-adult-gu...

The new Surviving Sepsis Campaign guidelines were released late last month in Chicago.  This week’s episode highlights the most important changes to Dr. Hassaballa. Hint: Dr. Hassabolus is vindicated again.  Read the entire guidelines here: https://www.sccm.org/survivingsepsiscampaign  

Physicians’ jobs today are very hard. There are so many demands on their time, and there is not enough time in the day to do everything they need to do. So it is understandable that a busy clinician would ask “Who Cares?” When it comes to Clinical Documentation Improvement, or CDI. In reality, Doctors need to care about this stuff. In this episode, Dr. Hassaballa explains why. Article on physician...

Both obesity and protein calorie malnutrition are major comorbid conditions (MCC), and they are frequent targets of post-discharge denials by payers. In this episode of Healthcare Musings, Dr. Hassaballa explains why it is so important that these diagnoses are not only documented, but why our plan to address these conditions must always be documented.  GLIM Criteria: https://www.espen.org/educatio...

It has been six years, almost to the day, since I saw my first Covid patient in the ICU. So much has changed since then. In this insightful interview, Dr. Joseph Marine, a Johns Hopkins Cardiologist and Professor of Medicine, reflects on the COVID-19 pandemic, discussing what was learned, what could have been done differently, and the future of public health responses. Gain expert perspectives on...

The hospital ED or ICU is the absolute worst place to have a goals of care conversation. 

Primary Care is in trouble. The job is very hard, doesn’t pay as much as it should, and the numbers of PCPs is dwindling.  How can we save the field? Dr. Bobby Scott has another novel idea to help reduce the burden on Primary Care Physicians.  Our conversation is the subject of this week's episode on Healthcare Musings.  Dr. Bobby Scott: https://substack.com/@bobbyscottmd   Sensible Medicine artic...

There is a dire shortage of Primary Care Physicians, and it is projected to get even worse.  We need Primary Care Physicians, and creating more Residency slots takes years to come to fruition.  This week’s guest on the Healthcare Musings Podcast, Emergency Medicine physician Dr. Colleen Smith, has a novel idea to help relieve the shortage.  Dr. Smith’s Substack: https://substack.com/@drcolleensmit...

There is a common perception that hospitals are nonstop, money making machine machines. Reality, however, it’s quite different.  In this episode, I sit down with Mr. Ken Kaufman, a Managing Director at Kaufman Hall. He gives an eye-opening assessment of what It’s really like to run a hospital.  About Ken Kaufman: https://x.com/kenkaufman12  

There has been an uproar on the part of some over the new dietary guidelines published by the government ( www.realfood.gov ).  Is the uproad justified? I asked the perfect person: America's Cardiologist, Dr. Mohammed Alo ( https://www.dralo.net/ ). We had a great conversation. 

Telecritical care is part of the future of Critical Care Medicine in the United States and world. There are various models of implementing TeleICU programs, and one of them is a “hybrid” between on site and tele ICU.  How can this work in the most effective manner? I asked the perfect person: Dr. Mirko Villanueva of Sound Physicians. He is both a TeleIntensivist and Program Director. His insights...

Acute hypoxic respiratory failure is diagnosed by one of these three criteria:  PaO2 less than 60 mm Hg SpO2 less than 90%  PaO2/FiO2 ratio < 300  That's it. Payers like to add all sorts of clinical criteria alongside this. This is totally wrong, and we should not let them get away with this when they dispute the presence of acute hypoxic respiratory failure during post-discharge DRG denials. ...