Healthcare Musings

We are in the business of trying to stave off mortality. It is the life-blood of Critical Care Medicine. Here's the thing: sometimes, morbidity can bring a lifetime of suffering, and it can be worse than mortality. In this episode of Healthcare Musings, Dr. Hassaballa reflects on the paradox of morbidity being worse than mortality.

Is health insurance actually insurance? Is this why costs are so high? Are there other ways to pay for healthcare? I asked this and many more questions of Dr. Reinier Schuur, health policy analyst with the Center for Modern Health, a health policy think tank.  Our conversation was thought-provoking.  Center for Modern Health: https://substack.com/@reinierschuur   Article: https://open.substack.com/pub/centerformodernhealth/p/break-up-big-coverage-not-big-medicine?r=2d9b5g&utm_medium=ios 

Continuing in the mini-series “Voltaire in the ICU,” Dr. Hassaballa discusses end-of-life care and how best to frame the question of what people want done to themselves at the end of life. 

"Le mieux est l'ennemi du bien." These words were written by Voltaire, and it is popularly rendered as "The perfect is the enemy of the good." In the ICU, I have to make decisions every day on critically ill patients, and frequently, I have to not let the perfect be the enemy of the good. Sometimes, doing something is worse than doing nothing at all.  In this latest episode of the podcast, Dr. Hassaballa discusses how he heeds the advice of Voltaire when he works in the ICU. 

The US House passed the Sunshine Protection Act of 2026 on July 14. The American Academy of Sleep Medicine “condemned” the bill. For me, as a sleep physician, I also want DST to be permanent. I don’t buy the circadian misalignment arguments.  Sleep Research Society position statement: https://sleepresearchsociety.org/sleep-research-society-position-statement-supports-adoption-permanent-standard-time/

I was blessed to be a guest on the Healthcare Leadership Show by Marion Spears Karr. We had a wonderful conversation about gratitude, and how it is the physician leader’s superpower.  Marion Spears Karr on Linkedin: https://www.linkedin.com/in/marionspearskarr

Once again, randomized control trial data show that aggressive fluid strategies in septic shock are not harmful. Dr. Hassabolus is vindicated, yet again.  Many thanks to the PulmCCM Substack for its excellent analysis of the critical care literature: https://open.substack.com/pub/pulmccm/p/early-vasopressors-are-superior-to?r=2d9b5g&utm_medium=ios 

The things we say have an impact. The words we use actually do matter. In this episode, Dr. Hassaballa discusses the impact of changing one word in a phrase can have on the people with whom we interact. It’s part of how habit becomes ritual. 

Traditionally, the word “respect” means “high regard.” When we delve into its Latin root, however, we get a much deeper understanding. For me, it has changed my behavior.  This week’s episode is a reflection on last week’s amazing conversation with Marion Spears Karr.  Episode Link: https://www.healthcaremusings.com/taking-gratitude-from-habit-to-ritual-my-conversation-with-marion-spears-karr/

As leaders, do we thank our teams sincerely? Or is it simply a habit without any purpose or meaning?  My conversation with Marion Spears Karr, CEO of Inflow Executives and founder of the Authentic Gratitude Communication Framework (AGCF) Program, really brought home those questions to me as a leader.  Marion Spears Karr on LinkedIn: https://www.linkedin.com/in/marionspearskarr

On June 7, 2009 my eldest daughter, Bayan, died from complications of lymphoma. Ever since that day, there have been songs that have helped me deal with the grief of her loss. I call them, “The Soundtrack of my Grief.” The song I reflect on here is “Weightless,” by Natasha Bedingfield.  Song on Apple Music: https://music.apple.com/us/album/weightless-less-is-more-version/402882140?i=402882221 

Will AI replace all Doctors? How good is the medical literature? What about the hype in Medicine today? I asked these and many more questions of Dr. Bobby Dubois, and our conversation was insightful and illuminating.  Dr. Bobby's Podcast: https://drbobbylivelongandwell.com/  **Please note: There was a problem with the audio in the first third of the recording, which I tried to fix as best I could. Apologies for the glitch.**

When I first started practicing, progress notes in the medical record said nothing because physicians did not write legibly. Now, we have multi-page progress notes that are legible and also say nothing. Why are we still here? 

This is the first in a new series of soliloquies by Dr. Hassaballa called “Dr. H’s Verbal Hassaboluses.”  And for the very first one, he advises Residents and Fellows to PLEASE stop writing system-based notes. 

While we all trained at the Academy, most of the care provided to patients occurs in the Community. And it seems that, more and more, the research output from the Academy is not clinically relevant to the Community.  So, I wanted to discuss this with Dr. Scott Matson, an Academic Clinician-Scientist at the University of Kansas. Our conversation was very enlightening.  Dr. Matson’s Substack: https://substack.com/@behindtheslides

Six years ago, today, was the darkest day of the Covid 19 pandemic for me. And it was good for me that all my emotion came out at the time it did. 

The purpose of the healthcare system is to heal the sick, and unfortunately, it seem that the system has strayed from this purpose.  Gil Bashe, Chair of Global Health and Purpose for FINN Partners, reminds us of this purpose in his excellent book, "Healing the Sick Care System: Why People Matter."  I sat down with Gil Bashe to discuss his book on this week's episode of Healthcare Musings. It was as informative as it was therapeutic for me as a physician.  Gil Bashe on LinkedIn: https://www.linkedin.com/in/gilbashe/ Book: https://www.amazon.com/Healing-Sick-Care-System-People/dp/1613431805 

Sepsis is the number one diagnosis treated in most intensive care units across the world, and it can be very deadly in short order. Yet, is sepsis even a disease?  "No," according to Dr. Rafael Olive Leite, aka, the "Thoughtful Intensivist" on Substack.  According to him, the whole "sepsis epistemology" is flawed, and this is why he continuously rails against the Surviving Sepsis Campaign.  I have been following his work for quite some time, and so I thought it was high time to have him on the show and explain himself.  Our conversation was eye-opening.  The Thoughtful Intensivist Substack: https://thethoughtfulintensivist.substack.com/

The healthcare system is supposed to be centered around just one person: the patient. According to Matthew Zachary, however, the healthcare system has failed miserably in its mission. Of all the voices that have been heard on this podcast, the one that hasn't been heard is that of the patient...until now.  On this week's episode, I sat down with Matthew Zachary, patient advocate and all around amazing guy. Our conversation affected me in profound ways.  Learn more about Matthew Zachary at www.matthewzachary.com 

The 2026 Surviving Sepsis Guidelines were released last March in Chicago. Among the dozens of recommendations, there are 17 “strong” recommendations. In this episode, Dr. Hassaballa speaks about these 17 strong recommendations and its implications on clinical practice.  Surviving Sepsis Guidelines: https://sccm.org/survivingsepsiscampaign/guidelines-and-resources/surviving-sepsis-campaign-adult-guidelines 

The new Surviving Sepsis Campaign guidelines were released late last month in Chicago.  This week’s episode highlights the most important changes to Dr. Hassaballa. Hint: Dr. Hassabolus is vindicated again.  Read the entire guidelines here: https://www.sccm.org/survivingsepsiscampaign 

Physicians’ jobs today are very hard. There are so many demands on their time, and there is not enough time in the day to do everything they need to do. So it is understandable that a busy clinician would ask “Who Cares?” When it comes to Clinical Documentation Improvement, or CDI. In reality, Doctors need to care about this stuff. In this episode, Dr. Hassaballa explains why. Article on physician subsidies: https://www.beckershospitalreview.com/finance/the-rising-cost-of-physician-subsidies-in-10-numbers/   

Both obesity and protein calorie malnutrition are major comorbid conditions (MCC), and they are frequent targets of post-discharge denials by payers. In this episode of Healthcare Musings, Dr. Hassaballa explains why it is so important that these diagnoses are not only documented, but why our plan to address these conditions must always be documented.  GLIM Criteria: https://www.espen.org/education/glim 

It has been six years, almost to the day, since I saw my first Covid patient in the ICU. So much has changed since then. In this insightful interview, Dr. Joseph Marine, a Johns Hopkins Cardiologist and Professor of Medicine, reflects on the COVID-19 pandemic, discussing what was learned, what could have been done differently, and the future of public health responses. Gain expert perspectives on fear, masking, vaccines, and trust in health authorities. Dr. Marine on X: https://x.com/DrJMarine 

The hospital ED or ICU is the absolute worst place to have a goals of care conversation. 

Primary Care is in trouble. The job is very hard, doesn’t pay as much as it should, and the numbers of PCPs is dwindling.  How can we save the field? Dr. Bobby Scott has another novel idea to help reduce the burden on Primary Care Physicians.  Our conversation is the subject of this week's episode on Healthcare Musings.  Dr. Bobby Scott: https://substack.com/@bobbyscottmd  Sensible Medicine article: https://www.sensible-med.com/p/on-the-conservation-of-primary-care 

There is a dire shortage of Primary Care Physicians, and it is projected to get even worse.  We need Primary Care Physicians, and creating more Residency slots takes years to come to fruition.  This week’s guest on the Healthcare Musings Podcast, Emergency Medicine physician Dr. Colleen Smith, has a novel idea to help relieve the shortage.  Dr. Smith’s Substack: https://substack.com/@drcolleensmith 

There is a common perception that hospitals are nonstop, money making machine machines. Reality, however, it’s quite different.  In this episode, I sit down with Mr. Ken Kaufman, a Managing Director at Kaufman Hall. He gives an eye-opening assessment of what It’s really like to run a hospital.  About Ken Kaufman: https://x.com/kenkaufman12 

There has been an uproar on the part of some over the new dietary guidelines published by the government (www.realfood.gov).  Is the uproad justified? I asked the perfect person: America's Cardiologist, Dr. Mohammed Alo (https://www.dralo.net/). We had a great conversation. 

Telecritical care is part of the future of Critical Care Medicine in the United States and world. There are various models of implementing TeleICU programs, and one of them is a “hybrid” between on site and tele ICU.  How can this work in the most effective manner? I asked the perfect person: Dr. Mirko Villanueva of Sound Physicians. He is both a TeleIntensivist and Program Director. His insights are truly invaluable. To know more about what it’s like to be a teleIntensivist, see my conversation with Dr. Eugene Yeh: https://www.healthcaremusings.com/a-day-in-the-life-telecritical-care-with-dr-eugene-yeh/ 

Acute hypoxic respiratory failure is diagnosed by one of these three criteria:  PaO2 less than 60 mm Hg SpO2 less than 90%  PaO2/FiO2 ratio < 300  That's it. Payers like to add all sorts of clinical criteria alongside this. This is totally wrong, and we should not let them get away with this when they dispute the presence of acute hypoxic respiratory failure during post-discharge DRG denials.  During this episode, Dr. Hassaballa goes into the criteria of acute hypoxemic respiratory failure, so we can be better equipped to deal with the ever-increasing payer denials of this major co-morbid condition. 

Increasingly, insurance companies and third-party auditors are denying sepsis claims and DRGs based on the “Sepsis-3” article published almost 10 years ago.  Specifically, they contend that if there is no SOFA score of 2 or greater there is no sepsis. Not so fast. The article never said that, and this is crucial when fighting sepsis denials.  On this episode of the podcast, Dr. Hassaballa discusses this crucial fact to help hospitals and other providers fight these ever increasing sepsis denials.  Article link: https://jamanetwork.com/journals/jama/fullarticle/2492881

I was honored to be a guest on the Becker’s Healthcare Podcast. During the episode, I discussed how AI is transforming clinical care; the irreplaceable human elements of medicine; and the leadership values that guide my work. I also shared insights on physician excellence, system level improvement, and what inspires me as I look ahead to 2026. 

Ever since the death of my daughter on June 7, 2009, I have written and reflected on many things that remind me of her, including many popular songs. It is one of the ways the Lord saved my life after her death.  Today, on her birthday, I embark on a new series on Healthcare Musings: "The Soundtrack of My Grief," where I discuss those songs that have helped me cope with her death.  The first song upon which I will reflect is "Clarity," by Zedd.  Song link: https://music.apple.com/us/song/clarity-feat-foxes/1440861976 

Can an AI Chatbot version of you make an end-of-life decision if you cannot make it on your own? This possibility was brought up to me on a previous episode with Eiman Abdelmoneim. I was so intrigued by the possibility that I sat down with Dr. Muhammad Aurangzeb Ahmad, Resident Fellow at the Harborview Medical Center (UW Medicine). He is also Affiliate Assistant Professor in the Department of Computer Science at University of Washington Bothell and Affiliate Faculty member at Responsible AI Systems and Experiences, University of Washington.  One of his main focuses of research is LLMs and end of life. It was a fascinating conversation. 

Metabolic encephalopathy is a state of global cerebral dysfunction caused by systemic metabolic or toxic disturbances. Its presence raises the severity of illness of those patients afflicted with it, and it is a frequent denial target of payers.  It is essential that clinicians document this condition in the record when it is present. In this episode, Dr. Hassaballa discusses this diagnosis and provides essential tips on how to properly document this condition. 

There are two competing definitions of sepsis, called "Sepsis-2" and "Sepsis-3." They are vastly different, and it is causing enormous confusion with respect to diagnosing and coding for sepsis.  I assembled a panel of experts to discuss the proper coding of sepsis. Does a UTI with fever and tachycardia really constitute sepsis? Does CMS mandate a specific definition of sepsis? What about SOFA scores?  We delve into all of this and more. The panel for this episode is:  Dr. Erin Boyd  Dr. Ronald Hirsch Dr. Cesar Limjoco Shirlivia Parker  I learned a lot, and it has definitely affected my approach to patients with sepsis in the ICU. It has also further spawned future episodes about sepsis, so stay tuned. 

Scott Becker, Founder and Publisher of Becker's Healthcare, has a unique perspective on the state of the healthcare system in the United States. So, I wanted to sit down with him and get his insights as well.  He had amazing observations and thought-provoking suggestions regarding:  Healthcare Coverage for all Healthcare Quality Healthcare Cost Healthcare Access We delved into each during this fantastic conversation. 

The NY Times had an article detailing how people are turning to chatbots because they are frustrated with the medical system. As a physician and patient myself, I completely sympathize with both groups. We need to fix this problem.  In this episode, Dr. Hassaballa Summarizes the NY Time article (linked below) Explains why this phenomenon occurs Suggests what physicians need to do about this fact. NY Times article: https://www.nytimes.com/2025/11/16/briefing/meet-dr-chatgpt.html?unlocked_article_code=1.2U8.wvrB.zA5xQrxE6LSR&smid=url-share

Insurance payers have the money. Providers - hospitals and doctors - want the money. This seems to be an irreconcilable conflict. Is there a middle way?  I asked the perfect person this question: Jeff Alter of Sound Physicians. His insights were invaluable.  Jeff Alter on Linkedin: https://www.linkedin.com/in/jeffreydalter/ Sound Physicians: www.soundphysicians.com 

There is a growing battle between payers and providers, each using AI to get the most money. Are doctors and hospitals using these tools inappropriately?  Articles:  AI by Doctors: https://www.statnews.com/2025/08/20/ai-scribe-use-doctors-health-insurance-bills-may-rise/   AI by Insurers: https://www.statnews.com/2025/10/31/health-insurer-ai-fights-hospital-ai-coding-billing/

One of the most challenging aspects of our healthcare system is elder and sick care at home. Who can do it? How can you afford it? It can cause enormous stress.  Neal Shah, CEO of CareYaya, knows this challenge firsthand, and he came up with a brilliant solution that will, in my mind, revolutionize the care economy. I sit down with Neal and hear all about it.  Company: www.careyaya.org Neal Shah: https://www.linkedin.com/in/neal-shah-careyaya/    

How will Artificial Intelligence affect physicians? Will it take their jobs? Will it kill all of humanity? There are so many questions with respect to AI and healthcare, and so I had the perfect guest on to get answers to all of these important questions.  Eiman Abdelmoneim on LinkedIn: https://www.linkedin.com/in/eimanabdelmoneim/ 

I sat down with three amazing women leaders in the Medical field - Dr. Chia-Shing Yang, Dr. Simran Matta, and April Burke PA - and had a wide-ranging conversation about the challenges facing women in medicine and leadership, and the opportunities they have as well. This is, by far, one of my most favorite episodes. 

I understand why so many Radiologists put this phrase in their reports. It can frequently make things worse, and this is one of the many bad things fear of a malpractice suit has wrought. 

No matter which ICU in which I work, I am asked to keep the potassium levels more than 4. Is there any evidence for this? 

I have railed against some traits and trends of new students and residents these days. My conversation with one of my teachers, Dr. Richard Abrams, taught me a valuable lesson and made me change my attitude. 

If an insurance payer denies a claim, and we write an appeal. The very least the payer must do is write a letter in response. 

This is Environmental Services Week, where we honor a crucial member of the healthcare community: those who clean hospital rooms. 

Patients frequently base their relationships with Doctors on their first impression. And research shows that our attire has a lot to do with that first impression. On this week's episode, Dr. Hassaballa reviews the latest evidence on Physician attire and the patient-physician relationship.  Article: https://bmjopen.bmj.com/content/15/8/e100824