Dear Doc:
When I was recently hospitalized, I did not see my family doctor. Instead, another doctor took care of me in the hospital. He identified himself as a “hospitalist.” Can you tell me what a hospitalist does and what is their specialty?
Dear Reader:
Excellent question! If you are ever hospitalized, receiving care from a doctor that knows you and your medical history is always preferable, but it is not always possible. Many doctors have busy office practices and it is difficult for them to break away from 25 or more scheduled office patients to travel to the hospital to care for one or two hospitalized patients. In this day and age, hospitalized patients can be very ill with complicated medical conditions. The time to adequately perform a detailed history and physical, review laboratory, x-ray reports and formulate a plan of care can take more than an hour. Then there is the time consulting with other physicians, updating family members and following up on the tests that have been ordered.
In addition, the practice of medicine is always evolving and advancing as new scientific studies are completed and new pharmaceutical treatments are approved. Hospital-based therapies such as managing ventilators, interpreting complicated testing and preforming necessary procedures requires a skill set that needs to be practiced and performed with regularity to stay proficient. Hence, the creation of the HOSPITALIST!
The term “hospitalist” was coined in 1996 in a New England Journal of Medicine Article and is used to describe a medical provider whose primary focus is to care for a patient who is in the hospital. The hospital is, in a sense, the hospitalist physician’s office. Most hospitalists are board-certified in the specialty of internal medicine (adult medicine) and now, there are even specialty training programs to further train hospital-based physicians. Hospitalist doctors usually limit their practice to caring for patients in the hospital. They are experts at the intravenous medications that you may receive in the hospital, work to coordinate care with other consulting hospital physicians, and are available to follow up on testing that has been ordered while you are hospitalized. Other advantages to being cared for by a hospitalist include, the hospitalist’s availability to communicate directly with family members, deal with acute complications in a timely fashion, and to check on you more than once a day to ensure the prescribed treatment is having the desired effect. Once you are discharged from the hospital, your medical care and follow-up is turned over to your family doctor.
Hospitals often employee an entire team of hospitalist doctors and midlevel providers to care for patients in the hospital. The hospital views these hospital specialists as experts in attending to hospitalized patient’s needs, practicing efficient cost effective care, and providing a high level of service to the patient in terms of communication and education. Often, hospitalists become champions of patient safety in hospitals. They help to develop and streamline processes that effect medication safety, planning for safe discharges, and avoiding hospital errors. All of this is made possible by stationing a specialized group of doctors at the hospital who are available to provide care to the hospitalized patient 24-hours a day, 7-days a week.
Most of the area hospitals in the Rochester and Finger Lakes Region have hospitalist programs. At Clifton Springs Hospital & Clinic and Newark-Wayne Community Hospital, a well-trained group of physicians and midlevel providers are available to care for patients that are admitted to the hospital. Locally, our primary care physicians have expressed their approval of hospitalist programs. Hospitalists allow primary care doctors to care for their patients in their office in a more efficient way. Office-based providers can now care for their scheduled patients without interruptions from the hospital. These interruptions were previously necessary when they had the additional responsibility of caring for their hospitalized patients.
Not everyone has always been a fan of the hospitalist movement. There were concerns about how a doctor can care for a patient in the hospital without knowing their medical history. How does the hospital doctor learn about your history or how does your family doctor learn about what follow up you need after discharge from the hospital?
Communication and involving the primary care physician is the key to providing the very best care to hospitalized patients. In the Rochester Regional Eastern Region, family providers are contacted anytime one of their patients is admitted to the hospital. Hospitalists are encouraged to communicate with the primary care physicians to learn about pertinent facts of the past medical history and at the time of discharge, a summary of the hospital stay is created for the family doctor. This communication allows for a smooth transition of care between the inpatient (hospital care) to the outpatient (office based) world. It allows the family doctors to know and understand what issues need follow-up and allows the patient to be treated completely.
So the next time you need to be hospitalized, if you don’t see your doctor, take comfort in the fact that the doctor you will see is a specialist in hospital medicine. I would recommend that you confirm that your hospital doctor is in contact with your family doctor and you should have a safe, more efficient, shorter hospital stay!
Stay healthy and as Gandhi said “be the change you wish to see in the world.”
Dr. Nagpaul is a medical doctor and is board certified in Internal Medicine. He currently is the Medical Director at Newark-Wayne Community Hospital, DeMay Living Center and Wayne County Public Health. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions to our medical providers, please email Dr. Nagpaul at Arun.Nagpaul@rochesterregional.org and put “Ask a Doc” in the subject line.
