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Meet the Hospitalist

Have you had the chance to work with a hospitalist yet?  In this era of complicated systems and specialists of all descriptions — mentalists, profilers, forensic anthropologists and others come to mind, even if they are mostly fictional — it only makes sense that the increasingly complex world of patient care would have its own experts’ experts.

First described and outlined in 1996 by the New England Journal of Medicine, the term ‘hospitalist’ is used for a doctor who focuses on coordinating the care and treatment of people who have been hospitalized.  His or her office is the hospital itself.  These physicians are most often board-certified internists whose training makes them uniquely  familiar with all the variables of hospital care.  There are other experts in the field along with the internists, including pediatricians and family practice doctors.  The American Hospital Association estimates that there are more than 20,000 hospitalists currently practicing across the country.

The whole hospitalist sub-specialty thing appears to have emerged as a solution to an all too familiar problem: “Who’s in charge now that my dad’s in the hospital?”  Until the mid-1990s, the answer would have been easy – his primary care doctor.  But as patient care became more and more complicated and costly — the testing, the consults, the medication protocols, the follow-ups — it became harder and harder for doctors to manage their travels back and forth between their offices and the hospitals where they send their patients.  Family members and the primaries never seemed to be able to catch up with one another and no one seemed to know what was happening between visits.

The solution to all this frustration and inefficiency?  Enter the hospitalists, the experts in navigating his or her particular facility.  They know all the ins and outs of their institutions.  They know who does what, how to get a patient’s test results where they need to be, how to schedule the best diagnostics, the works.  They are on-site, responsive and resourceful.  Doesn’t it sound just brilliant?

And sometimes it is just that – brilliant.  And sometimes, of course, it isn’t.  The hospitalist solution is not magic or foolproof.  It has its downside along with its strengths.  Hospitalists work in shifts, for one thing, which means that more than one doctor is seeing your loved one during their stay.  And while one of those hospitalists might be in touch with a patient’s primary care physician, or at least his or her office, there is no way they are aware of that patient’s complete medical history.  The hospitalists and the patients are strangers to each other.

So what does all this mean for any of us with a loved one in a hospital that employs hospitalists?  It means we have to ask questions and learn how to manage getting the most from yet another medical professional.  This isn’t necessarily easy, but keep in mind that the most important thing here is getting our loved ones, our senior, our son or daughter, our friend, appropriate and timely care and treatment.

Here are some questions to ask a hospitalist that may help:

  • How long will you be on duty?  Given that these doctors work in shifts, you will no doubt be encountering at least several during the stay of your loved one.  This question will help you sort out who’s with your patient and when, which in turn will help you direct any questions and concerns to the appropriate hospitalist.
  • How and when can I get in touch with you?  The theory behind the whole hospitalist thing tells us that they are more accessible that the regular primary care doctors during a patient’s hospital stay.  But we still need to know how and when we can talk to the hospitalist.  Get the details, and the contact numbers.
  • Who else will be involved in taking care of my love one?  You know how confusing it can be in the hospital.  The care team is made up of many members and they all have different assignments.  The hospitalist is there for clarification, so ask away.  They will know who’s who and what’s what.  Don’t be embarrassed to repeat yourself, either.  It’s not a system that’s easy to navigate by outsiders (which means us!).
  • Are you sending my loved one’s results, charts and so on to their primary care doctor?  This is one of the hardest parts of the whole coordination-of-care puzzle:  making sure the patient’s primary care doctor stays in the loop.  It is extremely important that the patient’s primary and the hospitalist(s) keep communicating.  This is the only way to make sure that the patient continues to receive proper care.
  • When will my loved one be discharged?  This is not the simple question  it might appear to be, nor is the answer merely a day and time, especially with an elderly patient.  A whole bunch of things will need sorting: are they going straight home from here?  will they need therapy?  skilled nursing care? what about follow-up appointments?  special aids or equipment?  Post-hospital care options, including home care and nursing home care, take time to research and coordinate.  It’s the hospitalist who must sign off on any discharges, so they’re the ones to check with on release details.

In addition to the questions, double-check for the accuracy of any information the hospitalist and their team may have regarding your patient’s past medical background and current medications and prescriptions.  Always remember that the hospital staff is not you. You know your patient – they do not.  You are your loved one’s best, smartest advocate.  In this era of experts’ experts and specialists’ specialists, you’ve got to be the caregiver of caregivers.  So carry on.  Don’t worry about hurting a hospital staff member’s feelings by checking and rechecking.  Don’t worry about being a pest.  Mind your manners, but do your job!  See that your patient gets the best care possible.

Special thanks Agingcare LLC, 2012.

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