Down at the Docks
Adam Possner’s desire to better know his patients leads physicians to Baltimore’s shipyards.
Cardiologist Sheldon Gottlieb has treated patients who load and unload ships, drive heavy equipment at the docks, and monitor the flow of cargo through one of the nation’s busiest ports. Over the years, he has often wondered about the world framed by the tall, elegant cranes he can see from his hilltop Bayview office.
But it wasn’t until he visited Seagirt and Dundalk marine terminals last spring that the physician actually observed the work conditions of longshoremen and also gained a sense of their challenging schedule. "I didn’t realize how intense the atmosphere was … how relentless the pace of the work is."
Gottlieb was one of roughly 30 Hopkins physicians on a rare guided tour of the two Port of Baltimore terminals only three miles from their offices. Organized by Adam Possner, one of the chief residents of Johns Hopkins Bayview Medical Center’s internal medicine residency program, the two-hour journey brought the providers into a striking industrial landscape. For academics increasingly used to iPhone-size tasks, the outing was a powerful reminder of the satisfactions and stresses of physical labor. You might also consider it a preliminary step in the medical history-taking of an entire community.
"Mostly patients come to us and everything revolves around us and our exam rooms," says Possner. "This way you can see where someone works, which helps you empathize and connect more deeply with them."
Eager to learn more about the lives of his patients, Adam Possner began investigating industrial areas of Dundalk as a first-year resident. With the support of David Hellmann, vice dean and chair of medicine at Bayview, Possner organized the first Hopkins group tour at the steel mill at Sparrows Point two years ago. Hellmann says such outings embody medical pioneer William Osler’s belief that "it is much more important to know what sort of patient has a disease than what sort of a disease a patient has.
"Certainly one of the best ways to get to know the patient as a person is to visit where he or she works," he points out.
Shel Gottlieb used his new knowledge recently when treating a 350-pound worker admitted to Bayview for "sky-high" blood pressure and heart failure. The 27-year-old man told the cardiologist that he worked part time driving cars on and off ships.
"Oh, you mean the Ro-Ro ships?" Gottlieb asked, using port slang for the vessels that carry wheeled cargo.
"He gave me this big smile, like a kid who’d been recognized for doing something special," the doctor recalls. Before long, they were discussing various aspects of his work and reasons behind the large amount of weight the patient had gained in only one year. The young man said that because of his low seniority in the union, he never knew when he’d be called in to work and that the lack of control over his schedule was stressful. He also told the doctor about other difficulties, such as snoring and fitful sleeping.
"We were able to have a very real, fluid conversation about things he wouldn’t ordinarily have mentioned to me," Gottlieb says. "In this case, he knew that I understood what he was all about."
America’s Best … for 20 Years Running
Hopkins Hospital tops the U.S. News honor roll once again.
Johns Hopkins Hospital has extended its reign to an unprecedented 20th year as the nation’s "Best Hospital," ranking No. 1 overall in the U.S. News & World Report’s annual list. Hopkins placed first in five medical specialties—two more than last year—and among the top five in 10 others.
Repeating last year’s scenario, Hopkins accumulated 30 points in 15 specialties to earn the No. 1 spot, edging out Mayo Clinic’s 28 points. Hopkins placed first in Ear, Nose, and Throat; Gynecology; Neurology and Neurosurgery; Urology; and Rheumatology. Hopkins gained second place honors in Kidney Disorders, Ophthalmology, and Psychiatry.
U.S. News analyzed data on 4,852 medical centers to produce this year’s specialty rankings. Only 152 hospitals ranked in even one specialty, and of that number, only 14 hospitals made the honor roll. The magazine’s complex evaluation—used to determine 12 of the specialties—is based on a combination of criteria including death rates, reputation, and a set of care-related factors, such as nurse staffing and patient advocacy.
An Addition to the Hopkins Family
New agreement with All Children’s will expand reach in Florida.
|Photo by Rixon Photography
The summer months proved a fertile time for growth in the Johns Hopkins Health System (JHHS) family.
If all goes as planned, Florida’s All Children’s Hospital & Health System will soon join JHHS as a fully integrated member of Johns Hopkins Medicine.
All Children’s is a 259-bed freestanding pediatric hospital in St. Petersburg, Fla., with outreach facilities in eight west Florida counties.
"The full integration of All Children’s into Johns Hopkins Medicine offers a unique opportunity to both institutions," said Edward D. Miller, dean and CEO of Hopkins Medicine. "With this integration … Johns Hopkins Medicine can leverage the intellectual and human capital within its pediatrics programs to expand the reach and impact of its current clinical, teaching, and research programs.
The proposed transaction, which is expected to be finalized within the year, involves no financial exchange. But as pressures mount to help contain rising health care costs, All Children’s offer Hopkins a new source of revenue.
Building in time to focus on improving the delivery of health care.
An 80-hour workweek gives medical residents valuable insight to the hazards facing their patients. But it also leaves them scarce time to play a role in patient safety and quality improvement teams.
At Hopkins Hospital, one department is trying to change that. Anesthesiology and Critical Care Medicine introduced a revamped training program that sets aside two days a month when residents have no patient care duties. While some of that time is spent in board exam preparation, a journal club, and simulation exercises, a significant portion is devoted to quality and safety efforts.
Now the 71 residents are working on 11 projects. Among other efforts, they’re studying ways to improve communication among health care workers, increase recycling, and prevent postsurgical nausea and vomiting.
"We typically come to work and focus on the patients we have that day," says resident Jim Rothschild. "And that’s good to a point, but this is forcing us to take a step back and say, How can we improve how health care is delivered?"