Physician Advisory

Becker's Hospital ReviewApril 1, 2019

Becker's Hospital Review: 3 Questions with Ronald Hirsch

Physicians talking in a group and comparing notes

On April 2nd, Dr. Hirsch will speak at Becker's Hospital Review 10th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place April 1-4, 2019 in Chicago.


To learn more about the conference and Dr. Hirsch's session, click here.


Question: What is the biggest evolution you've seen among the hospitals/health systems you work with over the past 2-3 years?


Ronald Hirsch: Each year, the number of physician advisors being hired at hospitals is increasing. I recently gave two talks at the National Physician Advisor Conference sponsored by the American College of Physician Advisors. The meeting was sold out with over 380 attendees; two years ago, there were only 100 attendees. Physician advisors are invaluable in assuring the hospital’s success in optimizing throughput and length of stay, and ensuring physicians understand the importance of utilizing documentation that not only accurately portrays the severity of their patient’s illness but also enhances communication amongst the whole care team. They also play a crucial role in defending the hospital when claims are denied and more importantly using those denials to develop processes to prevent future denials.


Q: Most people understand innovation as starting something new. The lesser discussed side of innovation is when you stop something. What is one thing health systems would benefit from stopping, quitting or banning?


RH: I’m sure there are many who would answer this question by quickly stating that they would ban “copy and paste in the EHR.” Like any tool, copy and paste is a tremendous time saver when used appropriately. I tell doctors that they can copy and paste their prior notes, but each note must be carefully reviewed and edited to ensure everything is accurate. If the note contains something that they did not ask, examine, review or consider that day, they should delete it.


I think that many hospitals allow physicians to become complacent with keeping up with the medical literature—especially when it comes to medical interventions that have proven to be harmful. As an example, even though medical literature demonstrated that blood transfusions should not be triggered solely by the blood count, usually a hemoglobin of eight, and that the patient’s clinical condition and physiologic reserve must be considered, it took many years for that to be adopted nationwide. I am also certain you can still find hospitals where diabetics are treated with “sliding scale insulin” despite the proven lack of utility of such a practice. Dr. Laura Westafer, an emergency medicine physician in Massachusetts has compared this “unlearning” process to the Kubler-Ross steps of grieving, demonstrating how long it takes to stop these harmful practices. Dr. Vinay Prasad, an oncologist in Oregon, and Dr Adam Cifu, an internal medicine physician, wrote a book about this phenomenon entitled, “Ending Medical Reversals.” It is a book that every medical leader should read.


Q: Tell us about the last meaningful interaction you had with a patient.


RH: I have not practiced internal medicine for the past six years since I travel every week. But my last encounter was a few months ago, when I saw an old patient at a grocery store near my home. My former patient told me they still don’t have a new doctor since they have not been able to find one that comes close to replacing me. Could there be a bigger compliment?


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Author Bio: Includes all R1 articles from Becker's Hospital Review.