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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