Hospitalists Change Way Inpatients Are Cared For

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Hospitalists Change Way Inpatients Are Cared For

Dr. David Lipschitz

Anytime you are admitted to the hospital, there is one physician that you may have never previously met who becomes responsible for your care -- the hospitalist.

Hospitalists are internists who develop special training in the care of hospitalized patients. In recent years, the specialty has expanded greatly and led many in the medical community to examine their newfound role in assuring quality care.

A recent article published in the New England Journal of Medicine compared the outcome of care of patients by hospitalists with general internists and family physicians. In this study, hospitalists kept their patients in the hospital for shorter periods of time, and costs of care were less. But for every other parameter of care, there was no measurable advantage of being cared for by hospitalists rather than general internists or family physicians.

Hospitalists are uniquely qualified physicians who, as a team, staff the hospital 24 hours a day. They are always present in the case of an emergency and have the necessary expertise to oversee every step in the care process. They have no contact with patients before or after discharge, but they help expeditiously to make an accurate diagnosis, assure that the necessary tests and consultations are obtained promptly and identify, and treat any complications that develop.

Although hospitalists have improved efficiency and accuracy in many areas, there are some disadvantages. First, anytime patients are transferred from one physician to another there may be greater risks of errors. Additionally, without greater knowledge of the patient and his history, there may be a tendency to order unnecessary tests. Many patients are not made fully aware of the transition of care from one physician to another, and thus resent the fact that their own physician has no contact with them during the hospital stay.

Sometimes, particularly in academic centers where trainees work closely with attending physicians, patients can become confused about exactly who is responsible for their care. Without adequate communication, it is not uncommon for the patient's primary care physician not to be fully apprised of the outcome of the admission to the hospital. This leads to fragmentation of care, confusion, a frustrated patient, and -- in some cases -- a poorer outcome.

In the end, what does this mean for the average patient admitted to a hospital? Whenever you or a loved one is admitted to a hospital, you must understand the role of the hospitalist in order to navigate the health system. You must be an educated and empowered consumer of health care.

First, do not be surprised if you never see your primary care doctor. Always ask whether your primary care physician will be seeing you in the hospital and, if not, find out the name of the physician who will be responsible for your care during your hospital stay. Find out who the hospitalist is and seek him out; make sure you talk to him ahead of time and keep in close touch throughout the process.

If admitted to an academic medical center, be aware that you will most likely be seen by an intern, a resident or an attending physician. If a consultation is required, you may be seen by another resident, as well as the attending physician in that specialty. For many patients and their families, this arrangement can become confusing. Try not to get distracted by the many different physicians or interns rotating through the door.

Whenever you are admitted to any hospital, the key is knowing how to appropriately navigate the health care system. Make sure you understand your problem, the treatment plan, and the potential benefit and disadvantages of any planned intervention. If you have any questions, direct them to the hospitalist who is responsible for and coordinates your care.

And when you leave the hospital, always ask for a discharge summary. This will help you understand what happened during your hospital stay. Make sure you give a copy of this summary to your primary care physician so that he, too, is fully aware of your treatment. This will assure continuity of care and avoid misunderstandings that could interfere with your recovery.

Source:
Lifelong Health
Arcamax Publishing
http://www.arcamax.com
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at http://www.creators.com. More information is available at http://www.drdavidhealth.com.
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