Hospitalization: Do You Feel Your In Good Hands With A Hospitalist?

patients_first

The use of Hospitalists is not a new topic, however it is a hot, and ongoing topic. You will find Hospitalists working in every hospital through out the US.  There seems to be mixed feelings among people who have been an inpatient at a hospital over the last 15 years.

Hospitalists  interface with patients longer.

Hospitalists interface with patients longer. That makes them better at diagnosing conditions, interpreting tests and understanding the care pathway for patients,” David says. “They are also very involved in safety and patient quality improvement.

The statement above may be true, but there are many circumstances where patient care has declined, and the patient is more at risk because the Hospitalist knows nothing about the patient prior to admission to a hospital.

Physician continuity during hospitalization may be associated with important outcomes other than length of stay. Transfers of patient care responsibility from one hospital physician to another may result in loss of important clinical information, potentially resulting in unnecessary tests and/or treatments. Additionally, transfers of patient care challenge physicians’ ability to establish rapport with their patients, potentially affecting patient satisfaction.

Transfers of patient care responsibility from one hospital physician to another may result in loss of important clinical information, potentially resulting in unnecessary tests and/or treatments.

Some will argue that “Hospitalists improve length of stay because they build relationships with individuals in the organization. And when they build relationships, they get consultations faster, they get people tested faster and they are generally on top of things.”  There are people who will agree that Hospitalists improve the length of stay, however this is where I diverge with some personal insight.

  • Hospitalists do not know the patient prior to admission
  • If the patient has no family members to advocate on behalf of the patient, a lot of pertinent medical information can be left out.
  • It’s not common for them to speak with the patient’s family physician who can also fill in some very important gaps when it comes to a full treatment plan.
  • Patients, in many cases are discharged too early for cost savings purposes. Which means the chances of re-admission are higher.
  • A patient will generally have more than one Hospitalist, and the danger of this is the idea that in many hospitals they do not meet together on behalf of the patient. Each Hospitalist will look at the patient’s chart and read the last Hospitalist’s notes.
  • I want to emphasize, that in larger hospitals IE: Teaching Hospitals they do have team meetings, however it depends on what you- the patient happen to be admitted for with regards to ‘team meetings.’
  • It’s been my personal experience that one Hospitalist may tend to over ride the treatment plan of the admitting Hospitalist.  This can be detrimental to recovery if the Hospitalist changes and/or adds medications.  Unlike the patient’s Primary Care Physician who knows the patients entire history, the Hospitalist is focused on the admitting diagnosis.
  • Patients admitted with underlying conditions that are not documented are in danger of not receiving the proper medications, or being given medications that are contraindicated. This can be a fatal mistake.

According to an article in the New York Times, “Hospitalists don’t appear terribly popular with patients and families, however. When the founding New Old Age blogger Jane Gross wrote about these specialists last year, she touched off a wave of complaints from readers. Americans don’t cotton to programs and people who step between them and their doctors. “A good primary care physician is a permanent part of your life,” Mike C. from Monroe, N.J., wrote. “To hospitalists, if you drop dead on the way home, they’ve still done their job.”

Hospitalists don’t appear terribly popular with patients and families

One last observation- When patients are discharged too early, they may lack the proper care at home which leads to a fast re-admission, Emergency Room visit, or worst case scenerio: death.  Many patients are discharged to Nursing Home Facilities to recover instead of finishing their recovery in the hospital. It’s more cost effective to discharge a patient to a Nursing Home verses keeping them in the hospital.

If you have a loved one that is admitted to a hospital, it’s wise to bring their medication list, keep a list of underlying conditions that you can share with the admitting nurse and Physician.  Due to the fast pace of our Medical care shifting to cost savings as a priority trumping patient care it’s important that we, the consumers stay educated- it can be the difference between life and death.

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