Hooray for hospitalists

Hooray for hospitalists

Hospitalists, physicians who practice internal medicine solely within the inpatient setting, are profiled in today’s Boston Globe. One of the weirder things about hospitals is there usually aren’t many doctors around. Primary care physicians tend to round in the early hours of the day, and then patients are left with nursing and administrative staff the rest of the time. Hospitalists address that deficiency by actually being in the hospital most of the day.

The article profiles Dr. Faisal Hamada, who runs the hospitalist program at Brockton’s Caritas Good Samaritan Medical Center. He’s actually employed by Cogent Healthcare, an Irvine, CA –not Philadelphia as the article states– based provider of turnkey hospitalist programs. Cogent provides the hospitalists, support staff, protocols and IT systems. The company generates a return on investment for its clients by improving the quality and efficiency of the hospital. Because hospitalists are around they can make adjustments in a patient’s schedule during the course of a day, something a primary care is unlikely to do after rounds . That kind of intervention tends to improve length of stay.

Good hospitalists develop a rapport with community physicians, which is essential so that those physicians don’t feel like the hospitalists are stealing their patients. I’m not surprised that Dr. Hamada is complimentary to the community physicians, but it’s also a fact that hospitalists tend to be more competent working in the hospital than their community-based colleagues. Hospitalized patients tend to be very sick –sicker than office-based physicians are used to seeing. Hospitals also have their policies, procedures, and informal ways of getting things done. It’s easier for a hospitalist to be good at this part of the job than someone who is only in the hospital occasionally.

One of the common complaints about hospitalists, also echoed in this article, is that there is a gap in communication between the hospitalist and the primary care physician, so that patients can get in trouble in between the time they are discharged and the time they see their community doc again. But that actually shouldn’t be such a problem in Brockton. Unlike most hospitalist programs, Cogent has its own call center to follow up with discharged patients, and has specific protocols for communicating with community physicians. In addition, Brockton is one of the three Massachusetts communities that is being wired up with a health information exchange as part of the Massachusetts eHealth Collaborative. That should make it much more straightforward for hospital-based and community-based physicians to stay in touch. Patients will benefit.

October 30, 2006

5 thoughts on “Hooray for hospitalists”

  1. The explosion in the number of hospitalists represents a disturbing trend in the field of medicine. Hospitalist, regardless of their full time presence “in house” will never be able to compete with a skilled internist who has a continuity relationship with the admitted patient.

    This trend merely reflects the end result of economic forces and the laziness of primary care doctors. It is not an advance in medicine, but a form of deterioration.

    Hospitalist are often freshly trained and relatively inexperienced graduates who are more obsessed with reducing length of hospitalization that diagnosing and treating illness. Many act as “gate keeping”; in this case pushing patients toward the EXIT gate (discharge). As the trend continues, Americans will be subjected to more anonymous and less compassionate, if more “efficient”, care.

  2. Hospitalists caring for my elderly mother never contacted her PCP to find out why he admitted her (to come off Coumadin so that a test of ascites fluid could be done). Instead they doubled her dosage of Lasix and kept her on Coumadin for 5 days hoping that the ascites would “go away.” It took five days of leaving messages before I could find one to talk to, and I demanded that he call her PCP. Finally he did call the PCP, took her off Coumadin and did the test. She was so weak from the 12-day hospitalization (PCP said it would be “three or four days”) that she had to go to a short-term rehab facility. Hospitalists had taken her off Coumadin so didn’t put Coumadin on the list of her meds when she was transferred to the rehab facility. Took me three days to realize she wasn’t getting it and to get her back on it. Hospitalists could not put her back on it because she had been released from the hospital. Rehab’s attending physician could not do it because she had no medical history indicating a need for Coumadin. PCP had no authority at hospital or at rehab center. Unbelievable! Hospitalists wouldn’t talk to me (health care proxy) because Mom was “lucid.” But she is also blind and almost deaf so their explanations of proposed treatment were useless. She was never an “informed patient” and never gave “informed consent” to anything. She was terrified, and I was, too. Another story: A friend’s elderly husband had chronic diarrhea and incontinence for many months. When he was admitted to an ER for a possible stroke, the hospitalists put him on a prescription-dose of laxatives. Laxatives? For a possible stroke?? In a patient with chronic bowel problems? What were they thinking? Who are these people? Where are they trained? The theory of hospitalists may be excellent, but we need educated, competent, “common sense” physicians filling that role. Those are qualities that the family PCP brings to patient care and they’re sadly lacking with the hospitalists we’ve encountered so far.

  3. Pingback: A hospitalist-induced nightmare | Health Blog

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