Guest post: Lessons learned at the ACDIS Physician Advisor Exchange

by Howard Rodenberg, MD, MPH, CCDS

Mid-September found me in Boston for the ACDIS Physician Advisor Exchange. It was a great opportunity to meet folks I had only known from an ACDIS lecture, an article on the ACDIS Blog, or through the small rectangular lens of Microsoft Teams. This formidable body of experts gathered to discuss the unique challenges facing the CDI clinician.

(For the record, I do not include myself in the “group of experts.” First, because there are folks out there with much more experience than I who are building the future in ways I can only dream of. And also, because years ago I learned that an “expert” is just someone from out of town with a box of slides. As I had no PowerPoint, I did not qualify.)

I could use this space to tell you all the good things that came out of the program, but I’m not going to steal the potential thunder of your own physician advisor if they attended the meeting and want to claim that the most brilliant ideas shared are actually their own. (I do that all the time. As long as nobody says, “Where did you come up with that?” I’m good.) But I will share with you several overarching themes.

One is that the march of technology is endless, and at some point, we are going to need to take the approach of Ken Jennings, who in his Final Jeopardy answer versus Watson the Computer wrote, “I for one welcome our new computer overlords.” I am more convinced than ever that in a decades’ time, CDI as we know it will have morphed into a smaller, more focused enterprise mostly driven by semi-autonomous artificial intelligence (AI) and natural language processing (NLP) technology. The time to plan for that future is now.

I was also reminded that without strong medical staff leadership, most CDI efforts are doomed to fail. And I was most interested to learn that many high-performing CDI programs do not focus on traditional measures like case mix index (CMI), query rate, or financial impact, but instead focus their efforts upon documentation for quality measures. If the documentation reflects the true quality of care, the CMI and other measures of fiscal impact take care of themselves.

But that’s not what you’ve come to expect from my CDI travelogues. Here’s what you really need to know:

The meeting was held at the Omni Parker House Hotel. The Parker House opened in the same site in 1855; the current building was opened in 1927. It is reported to be the oldest continually operating hotel in the United States. According to our friends at Wikipedia (so you know it must be true):

The hotel was home to the Saturday Club, which met on the fourth Saturday of every month, except during July, August, and September. Among the Saturday Club’s nineteenth-century members were poet, essayist, and preeminent transcendentalist Ralph Waldo Emerson, poet and The Atlantic Monthly editor James Russell Lowell, novelist Nathaniel Hawthorne, poets John Greenleaf Whittier and Henry Wadsworth Longfellow, diplomat Charles Francis Adams, historian Francis Parkman, and sage-about-town Dr. Oliver Wendell Holmes, Sr.

(I am personally going to apply for the job of “Sage-About-Town.”)

Among other notables, Charles Dickens stayed in the Parker House, and supposedly practiced his public recitations, including the premiere of A Christmas Carol, in front of a mirror that is now in the hallway of our meeting space. And you remember actor John Wilkes Booth? That guy who jumped the stage at Ford’s Theater? He stayed at the hotel just before his journey to Washington and was seen practicing at a firing range. Oops.

The Parker House also originated Boston Cream Pie, which is not a pie but a cake, and which was declared the official Massachusetts state dessert in 1996, beating out the Toll House Cookie which also hails from the Old Bay Colony. I ate a lot of Boston Cream Pie. The Parker House Roll, essentially a flattened crescent roll, was invented at the hotel as well. I did not eat any of these, because, well, there was cake instead. Finally, I am informed that someone at the Parker House came with the word “scrod,” which is a term for the “freshest, finest, and youngest white fish of the day,” but really sounds like something you should treat with an antifungal cream.

Two last thoughts on the Parker House. First, people in the 1920s were short. If you’ve been exposed to any kind of late 20th-century nutrition, you won’t fit in the bathtub. And, secondly, you know it’s a class hotel because half of the trinkets in the gift shop are labeled “HARVARD.”

A few other notes from my travels:

1. The Old North End of Boston is full of wonderful Italian restaurants. Do not go anywhere that looks slick and clean and seems to be populated with rich young pretty people. Go to the hole in the wall with a family name and the old guy sitting outside. If you get old on a diet of nothing but pasta and wine, it must be healthy, right?
2. There are many historic burying grounds in Boston, and each is a testament to the fact that all of us, no matter how prominent, eventually end up in the same state. But deeper thoughts aside, I began to lament how many good Puritan names we’ve lost over time. I’m especially sad to see “virtue names” like Temperance, Charity, Mercy, Verity, Prudence, Honor, and Patience vanish from our midst. One of my favorites for men is Increase, as in Increase Mather (the father of Cotton Mather, who also had a great name), who was influential in the Salem Witch Trials, as was Judge Wait-Still Winthrop, who was not only the grandson of the most famous early Governor of the Massachusetts Bay colony John Winthrop but the owner of yet another great Puritan name. One shudders to think what today's “virtue names” might be. Avarice? Wokeness? Inequity? Karen? Kardashian?
3. If you tour the USS Constitution at the Boston Navy Yard, please be aware that there are chemical toilets in active use within the officer’s quarters on the second deck down. They are at the stern end of the ship, which is probably related to the term “poop deck.”
4. Do not anger a trauma surgeon, for they can whip out your spleen with a spoon and do so in under four minutes. And be aware that some trauma surgeons have a group of supporters who will hold you down while the still-pulsing spheroid is excised, Aztec-style, springing into action at the code word, “Brian Murphy.”
5. Etiquette note: When you ask the hotel concierge for a restaurant referral, and you ask him to recommend a place so good he would take a date there, always follow that up as he looks upon you and your male friends with an explanatory burst of “No. No. No! I mean, it’s okay, but not us!” On the other hand, it is always appropriate to join a bus tour with a female colleague and loudly proclaim to those nearby, “Hi! It’s our first Match.Com date!”
6. Speaking of bus tours, if you go on a nighttime graveyard tour and have your picture taken outside the trolley with one of the supernatural guides, be prepared for that guide to stalk you for the rest of your days on this planet.
7. According to the helpful TSA agent at Boston Logan Airport, the most common non-bagged items that go through security are boxes from Mike’s Pastry, including my two boxes of cream puffs and lobster tails. (A lobster tail is a cornucopia-shaped pastry filled with cream and dusted with powdered sugar so wonderful that I have a video of the Beloved Dental Empress singing praises to the baked delight using the melody of “O Solo Mio.”) And speaking of the TSA, if you put four cans of Allagash White beer in your packed luggage, when you arrive home one of them is likely to be gone along with a note inside suggesting your bag was selected for “special screening.”
8. If you learn someone is dating a high school science teacher, probably best not to go for the easy Dad Joke and ask if they have good chemistry. You might get your spleen removed with a spoon.

Now that I know who the cool kids are, I’m looking forward to next year!

Editor’s note: Rodenberg is the adult physician advisor for CDI at Baptist Health in Jacksonville, Florida. Contact him at howard.rodenberg@bmcjax.com or follow his personal blog at writingwithscissors.blogspot.com. Opinions expressed are those of the authors and do not necessarily represent those of ACDIS, HCPro, or any of its subsidiaries.