Articles: Medical Topics
The Hospitalist
 "Bill,
I'd like to introduce myself. I'm Dr. Miller, your hospitalist."
According to a recent issue of Hospitals and Healthcare
Networks, an emerging new breed of doctors is beginning
to take over inpatient care. The hospitalist is a doctor
who works solely in the hospital to manage the care of the
hospitalized patient. Although this trend has been in place
for years in England and Canada, the idea of having a hospitalist
in charge of the patient's inpatient hospital admission
is a radical departure from the past. While the primary
care doctor may recognize the need to get the patient admitted
to the hospital, the care of the patient is then turned
over to the hospitalist. This transference of responsibility
has implications for the quality of care given to patients,
and could be a factor in a medical malpractice case.
Proponents of the system say
that harried primary care doctors lack the time to squeeze
in visits to hospitalized patients. Only the sickest patients
are admitted to hospitals these days. With fewer and fewer
patients in the hospital, the primary care doctor is torn
between seeing a busy schedule of patients versus devoting
time to overseeing the needs of the sick patient in the
hospital. The primary care doctor's skills are in jeopardy
of becoming rusty as the number of patients being managed
in the hospital continues to decline. Certainly, inadequate
skills leading to errors in diagnosis or treatment can result
to harm to patients and the filing of a malpractice claim.
As specialists in hospital
care, the use of hospitalists is expected to counter the
practice of bringing in a variety of specialists to manage
different aspects of the patient's illness. Hospital costs
and patient bills are driven up by a list of expensive consultations.
Hospitalists provide around the clock medical care, allowing
primary care doctors to go home at the end of a long office
day and relax.
Are primary care doctors happy
to be able to turn off their beepers at night when they
turn their patients over to a hospitalist? Not surprisingly,
the reaction is mixed. One likely response is anger over
having to give up control over the patient once the hospitalization
occurs. The choice of overseeing the admission may be taken
away from the primary care doctor, as some health plans
require hospitalists to take over the patient's care. If
the primary care doctor sees the patient in the hospital,
this is likely to be deemed a "social visit" and
not reimbursable. The personalized care and trust that is
often established in the primary care doctor-patient relationship
can be missing between a stranger (the hospitalist) and
the patient. As medical malpractice attorneys know, lack
of communication and trust coupled with a bad outcome can
lead to a visit to an attorney. This trend bears watching,
and should create a new avenue to explore during the discovery
phase of a lawsuit.
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