Thursday, March 19, 2009

The Trend Toward Hospitalists

The Oregonian published a feature this week about a Portland doctor who was recently named one of the nation's top 10 hospitalists by the American College of Physicians.

It's a apparently a growing trend that instead of being cared for in the hospital by a doctor who knows you and your case, you instead see a "house" physician, who works full-time for the hospital and whose primary job, apparently, is to get you discharged as quickly as possible.

From the article:

(Dr. Tim) Thunder, 37, says he's a good match for the hospitalist job because he's a multitasker who likes immediate results.

"I like to come up with a treatment plan and help a patient get out of the hospital," he says, "rather than the long-term chronic-care management, which is really important but isn't what a hospitalist does."

Thunder also says: "And because our entire practice is in the hospital, we look very carefully at how patients move through. Are we moving people through in a quick and safe manner? As opposed to the primary doctor, who is focused more on the individual patient.

I can understand that using hospitalists saves money. As Thunder says, hospitalists focus on moving patients through the system faster. And the faster someone gets out of the hospital, the less money it costs everyone. (Is it more profitable for hospitals to have their beds turn over? Or does it not matter as long as beds are occupied?)

From the patient standpoint, though, I want a doctor who's focused on me as an individual. As my health gets more and more complicated, I dread having to give my history to yet another new doc. My chart is so thick, it's not like any new doc can just skim it and understand everything I've been through and all the tests that have been done.

I know my primary care doc cares about me as a person, not just as a statistic. When I was in the hospital early in my illness, she visited daily to check on my progress and discuss the results of the latest batch of tests.

When patients are in the hospital, we're at our most vulnerable. We're probably feeling at our worst, and therefore are not as able to advocate for ourselves as we can normally. It can only help to have a doctor who's familiar with our history and our case guiding our treatment in the hospital. Yes, I do believe that sometimes a fresh pair of eyes can see something that the treating physician may have missed or ignored. But I don't think the primary care doc should be taken out of the equation entirely during the hospital stay and then have to mop up once the patient is discharged.

Am I wrong? Is this really a better quality of health care? Or is it just another cost-cutting measure to get around Medicare and insurance company reimbursements? (Do hospitalists get paid more than primary care docs?)

Ok, I just need to get one more vent off my chest while on the topic of this Oregonian article.

Dr. Thunder breezes into an 83-year-old woman's hospital room and says, "Hi Beatrice. I'm Dr. Thunder."

What's up with that? Why do some doctors not realize how disrespectful it is to call an elderly woman (or anyone, really!) by their first name upon first meeting and yet introduce themselves as Doctor So-and-so?

Yes, I know I'm a bit old-fashioned.

I like it when a new doc addresses me as Ms. Brandt until I tell him to call me Aviva. Or, even better, asks me how I'd like to be addressed. I also like it when doctors introduce themselves with a first name, i.e. Dr. Joe Smith. (And I hate it when nurses/medical assistants/dental hygienists refer to their boss as "doctor" like that's the person's name and not their title. "Doctor says you should ..." )

Just call me a curmudgeon.

[Note: The link to the Oregonian article will likely only be good for a week or two. Then their articles move into a pay-for-access archive. Sorry if you're seeing this past when you can view the article.]


Paul said...

You are so right! There is so little respect giving to people.
It would be nice if they cared a little more but this get them in and out attitude is going to hurt somebody!

Just Jenn said...

I'm sure being a for profit hospital has its challenges between making their bottom line and giving quality care. It's just not right that the patients should be the ones to fall through the cracks.