Stay on your hospitalist”s good side

Patients who end up in the hospital (I’m not talking about folks who are going in for elective surgery) are a whole lot sicker than they used to be. Patients who were sick enough to gain admission to the ICU when I was in training would never make it in 2005. They’re just not sick enough. And many patients with chronic illnesses, whom we used to care for in the hospital, are now followed as outpatients, in doctors’ offices, specialty clinics and even at home.

So you have to be pretty sick to be admitted to the hospital these days. Once in the hospital, there is a push by your insurance company, be it private or public, to get you out as soon as possible. These two forces have combined to give birth to the hospitalist movement.

The hospitalist is a doctor who practices solely in the hospital. The hospitalist is generally an internist, but there are pediatric hospitalists and family practice hospitalists who care for both adults and kids. When a primary care physician feels that a patient needs to be hospitalized, he or she can decide to turn over their inpatient care to the hospitalist.

This has several advantages. First, it frees up the primary care doc to concentrate on her (much sicker) office patients. As an ex-obstetrician, I can vouch for the chaos that hits an office schedule when a doctor gets called to the hospital.

Those who support the hospitalist movement are making certain assumptions: They assume that hospital care delivered by a small number of physicians who are specialists in hospital care will be of higher quality, cost less, and be more efficient and less variable than care given by many primary care physicians who may visit briefly only once or twice a day.

Studies have proven them correct in at least two of these arenas. They show that costs and hospital lengths of stay are lower in those patients cared for by hospitalists.

In this era of evidence-based medicine, hospitalists can play a role in assuring that hospital care is delivered according to “best practices.” They can participate in the development of protocols for the care of patients with common problems like pneumonia.

Studies show that such protocols improve patient safety and lead to fewer errors, always a good thing.

Another role that hospitalists play in hospitals across the country is as the doctor of record for patients who show up in hospital emergency rooms and need admission but have no primary care physician.

Often these patients are uninsured. They are a financial burden on hospitals and on-call doctors alike.

The hospitalist can relive that burden for overworked on-call doctors and try to streamline hospital care, thus reducing uncompensated care at the hospital.

How do patients accept having a stranger take over their care? How about communication with the primary care physician, who will assume care when the patient is discharged from the hospital? These are certainly areas for concern.

So far, patients have done well. The hospitalist is generally readily available for patient emergencies, to expedite care, and to meet with family members whenever they visit.

Communication with the primary care physician is vital. The hospitalist model can work only if information flows quickly and accurately back to the doctor’s office. Primary care docs must be kept in the loop, or they cannot care for their patients efficiently when they return to the office.

In Spokane, hospitalized Group Health patients are cared for by hospitalists. Sacred Heart and Deaconess hospitals employ hospitalists and are working to develop full-time hospitalist coverage.

According to the National Association of Inpatient Physicians, there are more than 3,000 hospitalists in the nation. A recent task force from Dartmouth University predicted that the hospitalist work force will reach 20,000 as our population ages.

Not all physicians make use of hospitalists, but as medicine continues to evolve, there may be one in your future.