Background: The US has the most expensive healthcare system globally.1 Recent claims have raised concerns that hospitalists may be in part contributing to higher levels of high intensity billing over time through upcoding.2 However, there is little empirical evidence on this topic. As the number of hospitalists continues to grow and hospitalists disproportionately care for [...]

Background: Hypertension occurs in up to 75% of hospitalized patients. However, less than 1% have “hypertensive emergency,” defined as severely elevated blood pressure (BP) with end-organ injury. Current guidelines support emergent treatment of hypertensive emergency but recommend against immediate reduction of severely elevated BP in patients without end-organ injury (i.e., asymptomatic hypertension). Recent literature suggests [...]

Case Presentation: 39-year-old African American male presented with dyspnea and hematuria for one week. His past medical history includes stage 3 CKD and hypertension. In the emergency room he was found to be severely hypertensive with systolic blood pressures hovering around 240 mmHg. Initial laboratory tests revealed significantly elevated creatinine level from baseline and new-onset [...]

Case Presentation: An 86-year-old woman with a history of hypertension on oral medications and chronic systolic heart failure presented to the hospital with chest pain and dyspnea. She was noted to be acutely hypertensive, tachypneic and hypoxemic. Physical exam revealed diffuse crackles, jugular venous distention and lower extremity pitting edema. EKG was consistent with an [...]

Case Presentation: Pachymeningeal enhancement (PME) is a radiological phenomenon describing the enhancement of the dura and outer layer of the arachnoid meninges best appreciated on contrast-enhanced MRI. We present a case of diffuse PME in the setting of a transient ischemic attack (TIA) which has been previously unreported. An 83-year old female with a history [...]

Case Presentation: A 36-year-old male with no significant past medical history presented with bilateral facial swelling at the behest of his wife. Discharged home. Two weeks later he presented for follow up with continued swelling and new onset fevers, night sweats, a 12-pound unintentional weight loss, and dyspnea on exertion, specifically reporting difficulty ascending one [...]

Case Presentation: A 22-year-old healthy female presented in April 2021 for abdominal pain during menstruation. Vital signs and workup with blood counts, metabolic, pregnancy, and sexually transmitted infection panels were unremarkable. Urinalysis showed nitrites, pyuria, bilirubin, and urobilinogen. Ultrasound and CT of the abdomen/pelvis were unremarkable. She was diagnosed with cystitis and prescribed cefuroxime. Urine [...]

Case Presentation: A 64 year-old male with a history of childhood polio leading to severe kyphoscoliosis presented to our hospital with four months of progressively worsening shortness of breath and was found to be in acute hypoxic and hypercapneic respiratory failure requiring noninvasive positive pressure ventilation (NPPV). On exam, he was altered and not responding [...]

Case Presentation: 66 year old male with past medical history of hypertension presented with complains of tingling sensations & weakness involving his hands for 2 weeks. His initial symptoms began with weakness involving bilateral feet, legs & hamstrings that started about 10 weeks prior to this presentation. He received moderna vaccine 1 month prior to [...]

Background: Imagine opening your patients’ electronic medical record (EMR) and seeing their stories, as told by them. Would that help you understand your patients better, both their resilience and the barriers they have faced? Systemic structures of oppression and health provider unconscious bias are root causes of racial, gender and class-based health disparities. Storytelling is [...]