The Hospitalists

Paula LabrotBy Paula Labrot

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The Hospitalists
Today’s medical care system is severely broken. When the bad thing happens, as patients, we need support and advocates to guide us. Millennials are often derogatorily accused of being and acting “entitled,” meaning they possess feelings of having a right to certain benefits or privileges. But, when you think about it, maybe that entitled feeling is not all bad, especially in a free society. After all, our very own Declaration of Independence states quite clearly, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” I think it’s a good thing to expect certain things like equal justice or access to education. I think it’s a good thing to expect the food supply to be safe or our water to be clean. I think it’s a good thing to expect providers to take good care of you when you are in the hospital. But what I think patients are entitled to is not what many are experiencing. There is a system problem. The providers are good people, but the systems they work in prevent them, actually prevent them, from acting as true healers. What follows is meant as a patient guide for 21st century hospital care. A Little History The modern term ‘hospitalist’ was coined in 1996 by Dr. Robert Wachter and Dr. Lee Goldman. They developed the field as a way of providing skilled physicians available to patients in the hospital 24/7. Previous to the rise in hospitalist care, a patient’s primary provider would do rounds once or twice a day on hospitalized patients and work at their offices in between visits, rushing to the hospital for emergencies. Critical care physicians manned the intensive care units in shifts. Today, being a hospitalist works out well for providers who want regular hours. Salaries range from $256,000 to $310,000 a year, and there is no need to worry about billing or directly dealing with insurers or maintaining an office and staff or the commitment of the long-term management of complicated, chronically compromised patients. How it Works The modern patient’s primary doctor’s care stops at the door of the hospital. In-hospital treatment is provided by hospitalists who are, usually, internists trained in acute care. They are tasked with “improving quality of care, reducing length of stay and lowering the cost of care.” Look at these three tasks and start thinking about how the first task may be compromised by pressure from the other two tasks. You are treated for the cause of your hospitalization. All other care must be done as an outpatient. According to Dr. John Krisa, writing for Society of Hospital Medicine, “Although there are many benefits to the hospital medicine model of inpatient care, there is perhaps no greater Achilles heel than the discontinuity inherent to the care model.” Lack of continuity among a patient’s health care support team has inherent safety issues. While it is true that electronic medical records (EMRs) make a patient’s history available to any of the health support team, you have to understand how cumbersome these records are and how much time it takes to find information which is buried in layers and layers of digital pages. Tips for the Patient from Aging Care and Elsewhere Have an advocate! Someone whom you trust who will go with you and watch over your care while you are in the hospital. Don’t go alone, if you can help it! To get the best out of a hospitalist’s unique and helpful skill set, set up a line of communication with your regular provider first. It’s easy these days to keep in touch on apps like MyChart. Set that up with your doctor before you get admitted. That way, you or your advocate can ask your doctor to interface with the hospitalist when you need to. • Check that your prescription history is correct in the record. Remember, the hospitalist doesn’t know you or your history. Ask the hospitalist, how and when you may contact them and when they are available to talk to your advocates. Ask the hospitalist if they are sending all your results and notes to your primary doctor and check with the primary doctor on your progress daily. Expect to be billed for a zoom or phone visit from your primary. If a patient has multiple system problems, the hospitalist may be reluctant to call in consults on ancillary problems. Ask your primary to do it, in case you need a gastro, neuro, psych, etc. consult so you don’t have to be running around to a million offices when you are discharged. If you will need extra care, ask your primary to order home health services for you which may include physical therapy, instead of being shipped off to a step-down facility. I use Attain Home Health for our family. Expect Service If, as the head hospitalist of a major Los Angeles hospitalist group said, “Hospitalists are focusing strictly on diagnosing, treating, and stabilizing acute medical problems,” I want a doctor focusing strictly on diagnosing, treating, and stabilizing the whole patient. It’s the difference between person-centered and medical-problem-centered treatment. G and I both had a hospitalization this year. Both of us were stunned by the hospitalist visits. They never took off their stethoscopes and listened to chests or felt for the pulses in feet or did any kind of hands-on clinical exam. It was three-minute visits, almost all of it looking at or entering data into the computer. Those are the waters Millennials swim in. They don’t know any different, so they don’t know to expect a different kind of treatment. They are totally naïve about what they could expect and have no inkling of what good clinical medicine is. I don’t want to be taken care of in a paradigm that values getting me out quickly more than it values my life. If we are going to use hospitalists, and I do think many of them are excellent doctors, I am going to strongly support involving the primary caregiver much more in the process, including financially. I want someone in charge who knows me. Someone in charge with whom I have a relationship. It’s the Medical Arts, not the Medical Business! Vamos a ver… with soul!
Paula Labrot

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August 5, 2022

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