Healthcare Musings

On July 1, new doctors start their residency. On July 4, our nation celebrates its independence. This is fitting because, truly, we in the medical field are fighting for the freedom of our patients. 

Typically, we titrate Vascopressors to a mean arterial pressure of 65. Does this harm patient with septic shock? Dr. Hassabolus goes over the literature.

I am clearly in the aggressive fluid resuscitation camp for patients who present with septic shock or sepsis-induced hypotension. And I have been vindicated by the literature. CLASSIC: https://www.nejm.org/doi/full/10.1056/NEJMoa2202707 CLOVERS: https://www.nejm.org/doi/full/10.1056/NEJMoa2212663 CHEST Review: https://journal.chestnet.org/article/S0012-3692(23)00637-2/fulltext   ESICM Guidelines:...

I was taken aback by the term, "Medical Gaslighting," used in this recent article. So, I sat down with the principal author and discussed the article and its larger implications beyond Gynecology.  Article link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711

A malpractice lawsuit can be very stressful for physicians - it sure was stressful for me. So, are all plaintiff attorneys bad people? What about those physicians who are expert witnesses for plaintiffs? I asked this and much more of Dr. Jeff Willis, an Emergency Medicine physician who left bedside practice to do medical legal consulting full time. It was an eye-opening conversation.  Dr. Willis'...

Like it or not, compliance with the SEP-1 Bundle is here to stay, despite its questionable effect on outcomes. We can either rail against it or learn to how do it well. In this episode, to culminate Critical Care Awareness Month, Dr. Hassaballa shares tips on how to achieve good results with the SEP-1 bundle. 

PulmCCM is one of the best Substacks out there. So, I sat down with Dr. Matt Hoffman, Critical Care physician and creator of PulmCCM to discuss his journey and evidence-based medicine in general.    Substack Link: www.pulmccm.org   When Death Comes To The Intensivist: https://www.sensible-med.com/p/when-death-comes-to-the-intensivist  

In the last episode of the “Sleep in the ICU” series, Dr. Hassaballa goes through several easy tips to help get a good night’s sleep.  American Academy of Sleep Medicine Tips: https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/  

Dr. Hassaballa tells the story of when he filled in as a Tele-ICU Nurse. It wasn’t a pretty picture, and it highlights how important nurses truly are to the healthcare field.  A very Happy Nurses Week to every nurse in the world! There is no “care” in healthcare without nurses. 

In Part 2 of the Sleep in the ICU series, Dr. Hassaballa discusses the SCCM guidelines with respect to sleep in critically ill adults and what we should do in the ICU.  SCCM Guidelines: https://www.sccm.org/clinical-resources/guidelines/guidelines/guidelines-for-the-prevention-and-management-of-pa   SCCM Update: https://sccm.org/clinical-resources/guidelines/guidelines/focused-update-padis-guideli...

Dr. Adam Cifu is an award-winning Medical Educator and general internist at the University of Chicago. He also writes for the fantastic Substack, Sensible Medicine. I had a wonderful conversation with him about Medical Education and how it has changed and not changed over the years.    Dr. Cifu's books: https://www.adamcifu.com/books Sensible Medicine Substack: https://www.sensible-med.com/  

In the first of a two-part series about sleep in the intensive care unit, Dr. Hassaballa discusses the classic sleep deprivation studies and their implications on our own sleep. 

Unless one has lost a child, then he or she can never know the horror of the parents who just lost a child to measles in Texas.  For the latest on the Texas Measles Outbreak: https://www.dshs.texas.gov/news-alerts/measles-outbreak-2025  

In the latest installment of the Faith in the ICU Series, Dr. Hassaballa recounts a story that has always stayed with him. 

In this latest episode of the ICU Lecture Series, Dr. Hassaballa lectures to staff about the ICU Liberation Bundle.  Link: https://sccm.org/clinical-resources/iculiberation-home/abcdef-bundles  

Despite multiple specialty society guidelines recommending not to transfuse blood if the hemoglobin levels are above 7-8 g/dL, many physicians disregard the recommendations. Why is that? Dr. Hassaballa discusses this issue.    Article referenced in the show: https://www.pulmccm.org/p/guidelines-on-red-cell-transfusion  

In this latest ICU lecture series, Dr. Hassaballa discusses metabolic acidosis: how to diagnose it and what to do about it. 

What would someone who is BOTH a Critical Care and Palliative Care Doctor say about palliative care in the ICU? I asked one.    Links from the show:  The Coleman Palliative Medicine Training Program: https://colemanpalliative.org/   Research Articles referenced in the episode:  Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intens...

Many payers state that a 2016 Coding Clinics article allows them to deny sepsis DRGs. This is not true, and Dr. Hassaballa goes into the article and what is specifically says about sepsis. And, he issues an unequivocal condemnation of the murder of Brian Thompson. 

In the latest installment of the "Great Minds in Medicine" series, I sit down with Dr. Sergio Zanotti, Critical Care Chief Medical Officer for Sound Physicians. We had a wide-ranging discussion about medicine, critical care, and healthcare in general. It was, perhaps, one of my favorite conversations.    Discussed during the podcast:    The Ventilator (Hidden Brain Podcast): https://hiddenbrain.or...

Given that physicians frequently make life and death decisions, especially in the ICU, does being a physician weaken one's faith? Dr. Hassaballa reflects on his own experience of faith and being a doctor. 

Despite a strong recommendation by the American Society of Clinical Oncology in its guidelines, recent surveys indicate very few, if any at all, Oncologists refer patients to Palliative Care. This is a huge disservice. 

I sit down with Dr. Mohammad Alo, America's Cardiologist and great friend of mine, and we discuss all things cholesterol and social media best practices for Doctors.  Dr. Mohammad Alo on X: https://x.com/MohammedAlo   Website: dralo.net/links

Recent research shows that a substantial minority of patients have cognitive motor dissociation. This has many important implications for our practice of critical care medicine.    NEJM Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645 NY Times Column: https://www.nytimes.com/2025/01/11/opinion/covert-consciousness-unresponsive-brain.html    

Dr. Hassaballa discusses this recent review article and meta-analysis of the correction rate of hyponatremia and clinical outcomes.