Envisioning the Hospitalist

Edwin Leap underscores the difficulty of establishing your patient’s ‘baseline’ in the years to come:

the hospitalist is a physician whose practice is focused on admitting patients to the hospital, caring for them, and discharging them back to their regular physicians (if they have one) when the acute situation is over.

the idea of the hospitalists makes great sense, and probably bears much fruit… However, a relationship is severed. We have many community physicians who do not do hospital work. And more now that the hospitalist option exists. So let’s say I have patient X in the evening or on the weekend. His physician doesn’t admit. I call the hospitalist. ‘Patient X is having chest pain. His cardiac labs and EKG look alright, but it just seems concerning to me. Can we admit him?’ Hospitalist: ‘well, he doesn’t have risk factors and everything looks OK, what are we going to do? Do a second set of labs and let him see his doc tomorrow.’

Now, that was a technically correct encounter. But if his own doc had been on call, as in the past, he might have said ‘I’ve known him for years. He doesn’t complain. That isn’t like him. Let’s keep him overnight.’ Scientific? Maybe not. Possibly useful? Absolutely.

Medicine and relationship [edwinleap]