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A Piece of My Mind
February 23, 2016

What Now? What Next?

Author Affiliations
  • 1Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA. 2016;315(8):755-756. doi:10.1001/jama.2016.0227

For more than 30 years, I divided my clinical effort at a university teaching hospital about equally between outpatient pulmonary medicine and medical intensive care. The considerable effort required to maintain competence across such a broad expanse of clinical medicine has paid off for me in many ways. I have particularly appreciated the opportunity to apply in each of those venues lessons I learned from working in the other.

With the benefit of that cross-fertilization, my outpatient and inpatient practice style has tended to converge over the years, but not so for one central component of my clinical practice. I am proud of the degree to which I engage my outpatients in shared medical decision making. I am more circumspect about sharing responsibility for clinical management decisions with my acutely ill inpatients. Recent experience as a patient in my own medical intensive care unit (MICU) has reinforced my caution in that setting.

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