Hospitalists – a good idea?

When we got the letter from the hospital – offering the new hospitalist service to us .. we told 'em we would give it a try.  So for the past few weeks, if an adult patient of ours comes to the ED, we are supposed to get a call from the ED physician.  S/he will describe the situation, and we will have a choice of whether to admit the patient ourselves, or allow the hospitalist to care for the patient.  They assured us that there would be excellent care and good communication.  So we said we would give it a try.

It makes sense.  We usually have only one or two patients in the hospital.  Just driving there and back takes more time than seeing the patients, so it's a lot of time .. and one could argue that the patients may get better care and/or service from someone who is always in the hospital. 

But ..

Two nights ago, the husband of a patient called because his wife was in the hospital.  She was admitted "with a kidney infection" and now urology said that it wasn't .. and neurosurgery said it wasn't a herniated disc .. but no one had been "in charge" of the visit (from the family's perspective) .. and they were frustrated and angry.

"uhhhh"  says me.  I didn't even know she was in the hospital.  They never called me.  Just admitted her to the hospitalist service. 

So … like any geek-physician, I logged on to the hospital's computer system and saw that her WBC on admission was 6.5 .. and there were scant RBC (no wbc) on a cath urine specimen from admission.  Renal ultrasound was negative, and an MRI of the l/s spine showed mild herniation at L4/5 .. with no nerve root impingement.

Then I visited her in the hospital yesterday morning.  The admission H & P was dictated and very thorough.  From there, the four day admission read like a team of blind men were treating an elephant.  A different hospitalist saw her every day and ordered new tests and new specialist consultations.  She was confused and angry and the bottom line is that this poor woman had back pain.  Frustrating and painful .. but something that probably should have been managed outside of the hospital from the beginning. 

I nudged the very nice physician's assistant who was seeing her yesterday (for the first time) for the hospitalist service to discharge her asap .. and I would see her in the office in a few days.  I sat with her for five minutes and listened … something no one had done in four days .. and she felt much better … eager to go home.

Maybe this hospitalist thing isn't gonna work …

5 Replies to “Hospitalists – a good idea?”

  1. Every time I’m tempted to turn my hospital patients over the the hospitalist something happens to remind me how important it is for patients to have someone they know and trust looking out for them during their hospital stay. Going to the hospital may seem routine and inconsequential to us, but it’s a very big – and often scary – thing for our patients.

  2. I agree with your frustration. I just started as a private family doc, coming from a residency in which we had a very active and ideal hospital service. I find it frustrating that most of my patients go to a hospitalist service now – because hospital work is prohibitively costly for private practitioners under the dual crunches of rising malpractice costs and declining reimbursements. I actively support tort reform and EHR’s as two possible small steps. Take care!

  3. What you’re talking about isn’t limited to the hospitalist arena. Any time you’ve got someone seeing multiple specialists, there is a very good chance that no one is in charge of the case. It ought to be less likely with hospitalists, but its (obviously) still possible. I’d ask what the hospital’s practice is for making sure that there *is* someone in charge (and why it failed, or appeared to fail, this time). I’d also wonder why the patient never heard from a hospital ombudsman.

  4. This week was admitted to the local hospital and discovered that my internist no longer makes rounds. I was agitated and terribly upset and planned to fire her despite the fact that I had enourmous trust in her and she had seen me through a diffcult eight month when we were searching for the cause of bone lesions.

    When I saw her for a follow up visit she told me that in her opinion this was a safer way to go. The Hospital Based Doctor is there and would be there if any complications arose. She also said that she just could not keep up with rounds and seeing patients. She will be 50 next year. She assured me she would visit me daily while in the Hospital and monitor my care despite the fact that she was not the admitting doctor.

    I felt a little better, Now Friday I am still upset. But I am told by friends it is a major trend.

    I think it must be stopped by law if necessary.

    There is cancer in medicine and all walks of life that it killing civilizid society.That cancer is “the bottom line” when is should be “excellence.

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