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Textbook edition reflects evolution of hospital medicine

From the February ACP Internist, copyright © 2017 by the American College of Physicians

By Mollie Durkin

Medical textbooks bear the difficult task of keeping up with health care's constant changes. This year, however, the latest in hospital medicine knowledge is fresh off the press, with the first update of “Principles and Practice of Hospital Medicine” since its publication in 2012.

The textbook's second edition, edited by Sylvia McKean, MD, FACP, John Ross, MD, Daniel D. Dressler, MD, FACP, and Danielle Scheurer, MD, was published in December 2016 by ACP's publishing partner, McGraw-Hill, and features nearly 500 contributors. The print version, which includes about 2,300 full-color pages, is now available (with a discount for ACP members), as well as from other book retailers. The text's digital version, which offers highlighting, note-taking, and search capabilities, is available through Kindle and McGraw-Hill's subscription-based platform, AccessMedicine.

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An update for hospital medicine was essential, said Dr. McKean, the book's chief editor. “This edition exemplifies how the specialty of hospital medicine has evolved and the skills that hospitalists need to have,” she said. Dr. McKean recently spoke with ACP Hospitalist about the new book and the best way for physicians to use it.

Q: Why was there a need for a second edition?

A: We needed to update some of the information in the first edition. Medicine is rapidly evolving, so the changes reflect how hospital medicine and the specialties within hospital medicine have changed since initial publication. For example, the second edition provides more robust coverage of consultation medicine, rehabilitation medicine, oncology, palliative care, and transitions of care.

Q: How is the book organized?

A: The second edition has six major parts designed to cover issues of importance to hospitalists.

Part one, the specialty of hospital medicine and systems of care, addresses value-based medicine, critical decision making at the point of care, transitions of care, patient safety, and quality improvement. This part emphasizes hospital processes, such as the multidisciplinary approach, teamwork, prevention of hospital-acquired complications, and patient-centered communication.

Part two, medical consultation, explains what you really need to know about surgical patients in your role as a consultant.

Part three, rehabilitation and skilled nursing care, is a new addition written primarily by experts in rehabilitation medicine. Safely transitioning patients to other facilities requires an understanding of what kind of services they provide, appreciation of discharge timing, and bi-directional communication of critical information. In addition, this part may be a useful resource for hospitalists employed in rehabilitation facilities.

Part four, the approach to the patient at the bedside, includes common problems that may arise during hospitalization. This part focuses on vital signs, the physical examination, and initial laboratory tests that might help guide further diagnostic testing and specialty consultation. Approach to the patient at the bedside may be especially useful for nocturnists admitting patients overnight.

Part five, diagnostic testing and procedures, reviews the interpretation of tests usually obtained at the time of hospital admission. The procedure section highlights indications of procedures commonly performed by some hospitalists, the initial assessment, and prevention of complications.

Part six, clinical conditions in the inpatient setting, differs from textbooks that review major disciplines in internal medicine, such as cardiology, gastroenterology, and infectious disease, in that the focus is entirely on clinical conditions that require, or arise during, hospitalization. In addition, there are sections that have a particular relevance to the specialty of hospital medicine (e.g., high-value care, toxicology and addiction, palliative care, and geriatrics).

Q: Who should read this book? Is it intended for both practicing hospitalists and trainees?

A: Yes, and for other clinicians who attend on the wards, such as physician assistants and nurse practitioners. In addition, this textbook may be a useful resource for nonhospitalist attendings who care for inpatients, such as teaching attendings and medical subspecialists, and for physicians studying for recertification in the boards of internal medicine. Some primary care physicians may find this book useful when they refer patients to the hospital for admission.

Q: How does the new edition address high-value care?

A: Traditional, fee-for-service internal medicine doesn't factor in cost or the value of a procedure. Incumbent on all people practicing in the hospital is a consideration of risk versus benefit of each approach to diagnosis and treatment. Does this test or procedure change management by adding value to the person? To answer this question, the clinician must consider the care plan in the context of the prognosis for the patient, communicate this information to the patient, and understand the patient's values and preferences. The first edition covered high-value care, but not as explicitly as in the second edition (e.g., part one [value-based medicine] and part four [using prognosis to guide therapy]).

Q: Has anything from the prior edition been deleted or otherwise changed drastically?

A: We eliminated several chapters and combined others into existing chapters for less redundancy. We also tried to shorten each chapter, even if we didn't delete it. This edition is about 200 pages shorter despite adding some new content. Five chapters [in an electronic feature separate from the textbook] are exclusively on AccessMedicine. These chapters provide an overview of global health, the economics of hospital care, principles of medical ethics, the core competencies of hospital medicine, and bioterrorism.

Q: How would a practicing hospitalist reference this book?

A: For a provisional admission diagnosis of, for example, pneumonia, clinicians need to confirm a diagnosis of pneumonia, prescribe appropriate antibiotics, modify the treatment regimen when test results become available, and make recommendations about the duration of treatment. This textbook provides practical information about initial testing, chest radiology interpretation, and the diagnosis of different types of pneumonia. A hospitalist might then refer to the infectious disease section in part six of the textbook; the chapters on hospital-acquired pneumonia and community-acquired pneumonia provide specific recommendations at the point of care.

For an uncertain diagnosis such as weakness, a hospitalist might refer to part four in the textbook; the chapter on weakness explains how you localize the cause of weakness, based on presenting signs and symptoms. Then, depending on the suspected cause, a hospitalist might review the specific neurology chapter that practically addresses the problem.

Q: Would you recommend having this in the hospital with you?

A: You wouldn't be able to carry this book with you in the hospital; it's too big and bulky. The book may be available in office spaces, at work stations, or in the hospital library. Practicing hospitalists usually prefer access to online resources. Therefore, they can purchase an individual online version of the textbook, or their hospital may subscribe to AccessMedicine.

This story also appears in ACP Hospitalist.

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