House Staff Group Research Articles

The Joseph W. St Geme Jr Lecture: Striving for “Polygamy”

Physicians and their families are often conflicted about the task of meeting their responsibilities at work and at home. This is the stress of work-life balance. It is a topic that is rarely addressed directly in formal medical education seminars or lectures but one that frequently arises during informal discussions within groups of housestaff and more senior physicians—but rarely between these groups. My objectives in dedicating the Joseph W. St Geme Jr lecture to this topic are to (1) shine a bright light on the issues of work-life balance and, thus, open communication and discussion about it within the medical community, (2) suggest a new framework for thinking about work-life balance, and (3) make some practical suggestions that might help to lessen its stress. The issues of work-life balance are complex and can generate great emotion, so perhaps a 20-minute award-reception speech does not do it justice. On hearing the term “work-life balance” most people immediately conjure the image of the balanced (or sometimes unbalanced) scales (Fig 1). In this model the scales are in a dependent relationship with one another. Add weight to one side of the scales, and immediately the balance changes, altering the position of the other side of the fulcrum. One of my objectives is to change that image to a bigger vision—beyond just 2 sides to the balance—and thus, my title, “Striving for Polygamy.” What does this mean? The “polygamy” I intend here is a metaphor for conducting 3 simultaneous “marriages.” I obviously do not intend for anyone to break the marriage laws of their state or to encourage extramarital relationships. The “polygamy” I would like to strive for is one that has been addressed in a book by David Whyte.1 Mr Whyte is a poet, and for a thorny conundrum like the issue … Address correspondence to Stephen Ludwig, MD, Division of General Pediatrics, 12NW-82, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. E-mail: ludwig{at}email.chop.edu

The Joseph W. St. Geme Jr Lecture: Striving for “Polygamy”

Physicians and their families are often conflicted about the task of meeting their responsibilities at work and at home. This is the stress of work-life balance. This topic is rarely addressed directly in formal medical education seminars or lectures, but it frequently arises during informal discussions within groups of house staff and more senior physicians—but rarely between these groups. My objectives in dedicating the Joseph W. St Geme Jr Lecture to this topic are 1) to shine a bright light upon the issues of work-life balance and thus open communication and discussion about it within the medical community, 2) to suggest a new framework for thinking about work-life balance, and 3) to make some practical suggestions that might help to lessen its stress.

The Effectiveness of Warfarin Dosing from a Nomogram Compared with House Staff Dosing

The purpose of this study is to address the safety and efficacy of a warfarin dosing nomogram. Patients undergoing hip or knee arthroplasty were randomized to warfarin dosed by nomogram (n = 106) or by house staff (n = 110) during their hospital stay. The average daily dose of warfarin was 4.14 mg for the nomogram group and 4.18 mg for the house staff group. On postoperative day 4, the average international normalized ratio was 1.55 in the nomogram group compared with 1.59 in the house staff group. On postoperative day 4, 19.1% of the patients in the nomogram group had a therapeutic international normalized ratio, compared with 14.7% in the house staff group. There were no differences in bleeding or thrombotic complications in the 2 groups. This nomogram appears to be both safe and effective.

University hospital based care decreases recurrent preterm deliveries and costs in comparison to no prenatal care

Objective: To compare perinatal outcomes and total health care costs for patients with a previous history of preterm delivery cared for by an inner city university hospital house staff clinic versus patients who have not received any prenatal care. Study Design: We conducted a retrospective review of women with a history of preterm delivery between 1994 and 1996. The inclusion criteria was a history of at least one preterm delivery. Data were obtained on maternal demographics, complete past obstetrical history, and number of prenatal visits. Results: The study groups consisted of 96 house staff patients and 53 patients without prenatal care. The number of prior preterm births, incidence of recurrent preterm delivery, length of neonatal intensive care unit stay, and mother-infant costs were greater in the group without prenatal care. The mean gestational age at time of delivery, and mean birth weight were greater in the house staff group. Conclusion: Our study demonstrates that university hospital-based prenatal care decreases recurrent preterm delivery rates and health care costs when compared to lack of prenatal care. Prenatal care provided at academic centers, with a coordinated multidisciplinary approach, appears to have a positive impact on the problem of preterm deliveries.

Managed care does not lower costs but may result in poorer outcomes for patients with gestational diabetes

Objective: Our purpose was to compare the costs of prenatal care and subsequent maternal and neonatal outcomes in patients with gestational diabetes cared for in an inner-city university hospital house staff clinic versus an inner-city managed care organization. Study Design: A retrospective cohort study was conducted. The groups consisted of 115 patients with gestational diabetes who were cared for in a house staff clinic and a demographically similar group of 85 patients cared for in a neighborhood managed care organization. The groups were examined regarding baseline demographics, intensity of prenatal care, maternal and neonatal outcomes, and total cost of the provision of care. Results: There was no difference between groups in the total cost of maternal-infant care. A larger percentage of patients in the house staff group saw the physician frequently. In contrast, patients cared for in the managed care organization underwent more tests of fetal well-being. There was a greater rate of neonatal macrosomia in the managed care organization group compared with the house staff group. Conclusions: Managed care does not decrease the cost of caring for patients with gestational diabetes but does lead to a greater rate of neonatal macrosomia, which may reflect poorer glucose control.

Ombudsman rounds revisited—A controlled study of attitudinal change in response to liaison psychiatry teaching

The authors tested the hypothesis that the attitudes of interns in internal medicine could be positively altered by a weekly medical-psychiatric conference (ombudsman rounds) that is given for 4 months on the inpatient medical service. In order to diminish the effects of simulation a 48-item question-naire using a Q-sort design was employed. It was given both before and after the PGY-1 year to three groups of house staff: 1) an on-site experimental group (29 subjects), 2) an on-site control group (11 subjects), and 3) an off-site control group from a sister institution (13 subjects). When compared with either control group a statistically significant number of subjects in the experimental group changed positively. When the control groups were combined even greater statistical significance was achieved. The data suggest that attitudes of internal medicine trainees may be favorably altered by medical-psychiatric conferences on inpatient wards.

A faculty and house-staff group practice: report of an operational model.

The internal medicine group practice at Colorado General Hospital was formed in 1974 to improve patient care and educational experience for residents. Six residents, two faculty members, a nurse practitioner, a dietitian, and a group practice coordinator provide 24 hour-a-day, seven day-a-week care for 666 patients. The program features: a balanced degree of faculty and house staff involvement in direct patient care, a high level of accountability provided by the coordinator, and small group size. The first 19 months of operation are reviewed, and the program is contrasted with other group practices reported in the literature.

Effectiveness of certified nurse-midwives: A prospective evaluation study

A prospective evaluation study of the effectiveness of the services of certified nurse-midwives demonstrated that in a hospital setting the care of low-risk maternity patients provided by nurse-midwives was as effective as the provided by house staff physicians. A total of 438 low-risk maternity patients were studied. Selected outcomes pertaining to the prenatal period, labor and delivery, and early infancy demonstrated, with two exceptions, no significant differences. The two exceptions were: (1) overcompliance with appointment attendance was more common among the nurse-midwifery group of patients; (2) a higher rate of forceps delivery was reported among the house staff group of patients.

Can New House Staff Group Avert AMA Confrontation?

Can New House Staff Group Avert AMA Confrontation?