Homeless patients with chronic medical conditions who need long-term care often repeatedly present to emergency departments to receive treatment. Following a performance improvement analysis, clinicians at UCSF developed an emergency department–based team who work with the community to provide care for this challenging population. Hemal Kanzaria, MD, and Jack Chase, MD, discuss how UCSF has addressed this clinical problem.
There are hundreds of thousands of liver transplant patients, all of whom will be seen in general clinical practices. It is common for them to develop elevated liver enzymes—a potentially serious problem that may be a sign that the transplanted liver is failing. Traditionally, patients with these findings are sent to a liver transplant center for an inpatient workup. A new protocol facilitating management of most of these patients in routine outpatient clinics has been developed, greatly improving the efficiency of managing patients with this clinical problem. Fady Kaldas, MD, director of the Dumont-UCLA transplant center, discusses how to manage elevated liver function results in liver transplant patients on an outpatient basis.
As physicians age, they experience the inevitable decline of cognitive and physical function. It is not clear how that affects clinical practice. Jeffrey Saver, MD, vice chair of neurology at UCLA and a JAMA Associate Editor, discusses how to best assess the clinical performance of aging physicians.
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More than a third of the physician workforce is older than 60 years, and 10% are older than 70 years. Cognitive abilities may decline with age but how cognition affects clinical practice is unknown. It is also not clear how clinicians’ cognitive ability can be measured and acted upon when diminished without committing age discrimination. Two major academic hospitals launched programs to test cognitive abilities in older physicians applying for renewal of their medical staff privileges. It went well for one and not well for the other hospital. Yet, in the hospital where the testing program was carried out, several clinicians who were not suspected of having any problems had profoundly affected cognition. Leo Cooney, MD, from Yale-New Haven Medical Center, and Anne Weinacker, MD, from Stanford Health Care, discuss their experiences in dealing with these difficult issues.
Read the article: Cognitive Testing of Older Clinicians Prior to Recredentialing