By P. Lal Arora, M.D., FRCPC
It is not unusual these days that when a patient is admitted to the hospital, a physician who introduces himself or herself as a Hospitalist takes care of the patient. The patient may never see his or her own physician while in the hospital.
So, who are the Hospitalists, what do they do in the hospitals?
Hospitalists are trained physicians in their own specialty and very often Board Certified in their discipline. They exclusively work in the hospitals and take care of patients admitted under their care. Since many of the patients in the hospitals these days are patients with medical problems, most of these physicians are trained in the specialty of Internal Medicine. In certain Institutions, they also work in the department of General Surgery or Obstetrics.
Who determines that they are qualified to practice in a hospital setting?
The Hospitalist may be an employee of an outside agency or be hired by a hospital. But all of them go through the credentialing process developed by the Medical Staff and applicable to any physician seeking privileges to practice medicine in a particular institution.
They are also subject to peer review, required to maintain their License and Malpractice Insurance in good standing.
How do they help the patient or the hospital they work for?
The physicians in the community usually have obligations other than their patients in the hospital. They have almost universally office practice where they spend by far most of the time. Many physicians have patients in more than one hospital. Therefore, it was felt that it would perhaps improve the efficiency, the timeliness of response to patient needs and even improve patient care if they were taken care of by physicians exclusively devoted to care in the hospital. We have now experience over the past several years and it is for the most part the feeling of the practicing physicians that the Hospitalists have met the expectations.
What do Patients think of these Doctors?
The opinions are mixed at least in our community. Some patients are very happy with the care they receive from the Hospitalists while they are in the hospital. Others feel that their own physicians would rather take care of them.
Are their any Drawbacks in the System?
There is no perfect system especially in the health care and that any system is as good as we make it.
Patient loses contact with his or her own physician at the most critical part of an illness. There may be loss of continuity in care, loss of communication between a physician taking care of the patient in the hospital and the primary care physician who may have known the patient over many years. Every Institution has guidelines to improve communication between the Hospitalist and the Primary care physician, both verbally and in the written form. For example, many hospitals have a rule that the Primary care physician must be notified of admission of a patient to the hospital, with any change in patient’s condition and all the details be sent to the physician at the time of discharge in a timely fashion. Some hospitals have a policy that the Hospitalist continues to respond to the patient’s concerns, need for medications for a short duration after discharge till the continuity of care is re-established with patient’s own physician.
So, What I need to do when I am admitted in the Hospital under a Hospitalist?
Let the nursing staff or the physician taking care of you know that you would like your doctor notified of you being in the hospital and he/she should be called if there is change in my condition. A member of the family may do this if you are unable to do for yourself. Because of the privacy regulations, hospital staff at times is reluctant to give out this information without your or your family’s permission.
Some physicians visit their patients from time to time in the hospital as a courtesy. This also facilitates personal communication among the medical caregivers. You are also at liberty to request a visit by your own physician if there are issues you or your family wish to discuss.
Remind the Hospitalist and the nursing staff that you would like all the details of your hospital stay particularly any significant changes in your condition or in the medications be conveyed to your physician in a timely fashion after you leave the hospital.
Hospitalists are a group of physicians that provide care to our patients exclusively in a hospital setting.
They provide a useful and timely service and improve care of the patients in the hospital.
The limitation of the system includes lack of continuity of care and can only be improved by enhancing communication between the primary care physician and the hospitalist doctor.