The Eye Guy

Hospitalists- Friends or “Foes”?

Traditionally we have been accustomed to have a primary care physician who takes care of our medical problems in the office. If we must go to the hospital, this physician admits us, will order tests and visit us at the hospital once or twice a day- usually before or after office hours. If a problem occurs, the nurse will call the doctor who may order some medications over the phone until he or she can get out of the office to visit the patient. In a real emergency, the physician may not be able to get to the hospital quickly, especially if he or she admits patients to several hospitals which may be distant from the office.

In order to provide more efficient, and perhaps better, care, the concept of Hospitalists has evolved. Hospitalists are physicians who only provide inpatient care. The patient is sent to the hospital and transferred to the Hospitalists for the hospital care. The hospitalist does not have an office based practice. There is a hospitalist who is available all of the time, will coordinate the care with other medical and surgical physicians, as well as communicating with the patient and the family. When discharged from the hospital, the patient returns to the primary physician for continuing care. Most hospitalists are Internists (or Pediatricians). However, there are now obstetricians and other specialists who provide this type of care. There are over 10000 hospitalists in the United States today. Who benefits from hospitalist? EVERY BODY!!

With the hospitalist in the hospital of the time, there is increased efficiency, usually with a reduced hospital stay and significant cost saving. Also, diseases in hospital patients may manifest themselves differently than when seen in the office. The hospitalist may be better prepared to handle these changes. We have heard too often of patients who suddenly took a “turn for the worst.” The hospitalist is usually immediately available.

The hospitalist is usually hired by the hospital with billing by the hospital to the insurance company. The patient is always referred back to the physician. If your physician wants to come to the hospital and follow you there, that is usually possible.

For your personal physician, there is a marked increased efficiency in his or her practice. There may be an extra number of hours spent seeing patients without having to “rush” an office patient in order to get to the hospital for a sick patient there. It also improves his or her lifestyle, allowing more time for patients and family, Although the physician usually will take calls after hours, it is not necessary to go to the hospital in the middle of the night to admit a patient and care for him or her.

From the patient’s viewpoint, it becomes necessary to get to know another physician and to establish rapport with him or her. Over a period of time this will become a natural progression.

A major reason for hospitalists is recognizing that many physicians who are dedicated to their patients also have personal lives with families and other interests. With the shortage of physicians, this concept will, hopefully, attract more young people, especially women, into the primary care areas of medicine. It will also allow physicians to practice until a later age and to gradually phase out of their practices.

However, there are several legitimate concerns. Your personal physician knows you best and knows your medications and your idiosyncrasies. Sometimes this personal information is absolutely essential for the patient to get the best care. It is also essential that there must be significant communication between the referring physician and the hospitalist with the hospitalist immediately notifying the referring physician of any problems and the status upon discharge.

As with any new concept, it will be necessary for patients and physicians to adjust to new ways of practicing medicine. In hospitals with hospitalists, it is unusually not necessary for your physician to use them if they prefer to care for you in the hospital.

If your physician is referring you to a hospitatlist, discuss this openly so that you know what will happen and what to expect. There may be some drawback, but t is a great new concept which is of great benefit to patients- and physicians.

Frank J. Weinstock, MD,FACS is a Professor of Ophthalmology- NEOUCOM, and an Affiliate Clinical Professor at Florida Atlantic University. He lives in Boca Raton and Canton, Ohio

©2008 Frank Weinstock.