A major change in US health care over the past 15 years or so has been the rise of the hospitalist movement. My understanding is that hospitalists have been shown to improve some hospital-related metrics but I am not sure how thoroughly their effects have been examined.
This is an interesting article by Howard Beckman of Rochester, one of my former bosses.
Three Degrees of Separation — Ann Intern Med
In his article, Dr. Beckman succinctly highlights the dilemmas that patients, primary care physicians and even the hospitalists themselves face in the wake of the hospitalist movement. The dynamics of these relationships and a comparison of a system with and without the hospitalists are addressed in this article.
ReplyDeleteDr. Beckman’s concerns clearly revolve around the continuity of care, while transitioning from a PCP to the hospital setup. From the patient’s perspective, patients search for that ‘familiar’ face, which could be a ‘sounding board’ at the times that they need to make tough decisions. From the PCP’s perspective, there seems to be feeling of ‘alienation’, especially when the PCP is no longer involved while designing the care plan for the patient. From the hospitalist’s perspective, with a mastery over clinical protocols and treatment guidelines, the ‘treatment’ takes precedence over the ‘healing’ process of not only the patient, but also the family.
The hospitalist movement is not a recent development in the Western world. The coining of the term ‘hospitalist’ by Drs. Watcher and Goldman in 1996 coincided with the formalization of the ‘hospitalist’ movement in the US in response to the need for improved quality and efficiency and the advent of managed care. However, a system of ‘specialists in inpatient medicine’ has been an integral part of US hospitals from long before. An example of this would be the intensive care specialists who take over the care of patients admitted in the ICU from the primary care physician.
The hospitalists have met with success in not only providing but also coordinating care between various specialties within the hospital, achieving good clinical outcomes and consequently controlling costs. Then why is it that it that integration with the PCP and patient satisfaction still remains a challenge? In today’s rapidly evolving world of medicine and technology, it is a given that the hospitalists are here to stay. With a round-the-clock presence, an expertise in hospital based care and a commitment to hospital quality improvement initiatives the hospitalist becomes an integral part of the inpatient care arena. Addressing concerns about the formation of a ‘care team’ which will involve the primary care physician and extramural care givers of a patient, formulating a seamless transfer of information to and fro from the PCP practice and a strategy to facilitate the introduction of a new caregiver at the time of hospitalization may hold the key to the success of this quagmire!