From a dedicated hospital physician: things that the hospitalist movement can do better

I’ve been a hospital medicine doctor for the best part of a decade. During my residency, I often toyed with the idea of becoming a primary care physician (and still wouldn’t rule it out one day), but for my own circumstances and admittedly somewhat restless personality—hospital medicine ended up suiting me better. Since then, I’ve worked up and down the east coast in every type of hospital, and it’s allowed me to also get involved in a number of other non-clinical endeavors in the healthcare quality improvement realm.

As for the job itself, as mind-boggingly busy as it can get, I still find the work immensely rewarding. As much as the current system feels like it’s turning me into some type of a data-entry clerk and “type and click bot doctor”—instead of that ideal personable and compassionate doctor I always strive to be—I have devised my own techniques to stay true to the ideals of good medicine and get away from the computer screen.

The hospitalist movement has expanded exponentially over the last 20 years, the term “hospitalist” first coined in 1996 when it was mentioned in a New England Journal of Medicine article. At first considered somewhat controversial, there are now almost 50,000 practicing hospital medicine doctors in the US. It’s undoubtedly better for patients to have their doctor “in house” all the time, instead of just rounding in the hospital for a couple of hours in the morning before going back to their office. Having said that, here are 3 things the hospitalist movement can do better:

1. Continuity of care

Hospital physicians must try to promote continuity of care as much as possible. Avoid continuously switching doctors during a hospitalization. If patients are re-admitted, the same doctor should see them if available. The hospital doctor should also be in regular contact with the primary care physician. One of the best hospitalist programs I ever worked in, attached hospital doctors to a specific primary care group, where we were seen as “part of the team”.

2. Promotion of specialty

Hospital physicians in general, considering how crucial we are for the system to function, haven’t done a good job of making our presence felt in the hospital, and also communicating our role to the general public. We are the “captain of the ship” for our patients, and should act us such. We should also be fierce advocates for great patient care, and make our concerns clearly known if we ever feel administrative requirements clash with this (better still, more of us should be in executive positions ourselves). At the same time, the system needs to allow us to spend adequate time with patients and their families, to skillfully coordinate often very complex hospitalizations

3. Attitude

I hate to say this, since I think most of my colleagues are awesome, but there is a sense among some (stress: a minority of) hospital physicians of not taking full ownership of what we do, and seeing ourselves only as temporary “shift workers”. I personally think of my patients as my complete responsibility while they are in the hospital. I don’t turn my pager off the second I leave the hospital, and tell the nurses to call me directly with any major issues until very late in the evening. I can’t just “check out” if I know I’m seeing that patient again first thing in the morning. I also tell them they can page me anytime in the few days after discharge if they have concerns, and am happy calling them at home to make sure they are doing okay

I have never been a fan of the word “hospitalist”, and avoid ever using that word, instead referring to myself simply as “Attending Physician”. Hospital-based internist or internal medicine physician are other terms I’ve had on my name badge. But regardless of what we call ourselves, our specialty drives key hospital metrics and is vital with the increased focus on raising quality and lowering costs. Hospital medicine is here to stay, and those of us in this specialty need to lead the way in healthcare.

Suneel Dhand is a physician, author, speaker and healthcare consultant. He has experience in a number of different healthcare environments, having worked up and down the East coast and also internationally. His specialty areas include hospital QI, optimizing healthcare IT, and improving the patient experience. He is the author of 3 books, including most recently “The Ultimate Patient Advocate in Your Pocket”, designed to help hospitalized patients. He is also the founder of HealthITImprove, an organization dedicated to improving and optimizing information technology at the frontlines of healthcare.

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