Hospitalists?

[agate]

What's your opinion of hospitalists? They're being commonly used in US hospitals now.

In the past you went to a hospital because your primary care doctor or some other doctor who already knew you put you there, or you'd been to the ER and ended up there, and at that point your primary care doctor was notified and was supposed to visit you at the hospital during rounds.

Now you go to a hospital and a hospitalist, who works at that hospital only, is assigned to you. The hospitalist is supposed to be in contact with your regular doctor(s) and have access to your medical records.

The hospitalist assigned to you might change if you're in the hospital for a week or more because they are rotated. Any new hospitalist who comes along is supposed to be in touch with your regular doc and be aware of your medical history.

I understand that this system works well, and I can see why hospitals might opt for hospitalists instead of an influx of doctors from all over who breeze in and out.

Just wondering if anyone has had any experience with hospitals using hospitalists. What has your impression been?

I have problems with introducing a whole new person at a point where the patient may need urgent attention. It just seems as if someone who already knows the patient would be easier on all concerned. A person scrolling through a patient's medical record and probably in a hurry might miss something important, something that a patient's regular doctor would have a clear memory of.

[stillstANNding]

My mom liked her hospitalist. She was very good and treated Mom over two admissions.

OTOH, this system did not work for Joy. She was admitted 4 times from November to February and there was no continuity. She did not like the "hospitalist" system.

ANN

[agate]

That's what troubles me--the breakup in continuity. As soon as yet another person is introduced into the picture, everything gets more complicated because there should be communication among the various people involved, and it seems as if there often isn't.

If someone has an extensive medical record with quite a few severe medical problems, it's easy for someone new on the scene to overlook something--whereas a doctor who knows the patient would be more likely to have a memory of those medical problems. Or know how to find the record of them.

[Howie]

I have no opinion. I've only been in a hospital for eye surgery, then stayed overnight with my sister in a motel / hotel. Went the next day to meet with the surgeon, then done. I've been too healthy to be so sick.

[Lazarus]

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That's what troubles me--the breakup in continuity. As soon as yet another person is introduced into the picture, everything gets more complicated because there should be communication among the various people involved, and it seems as if there often isn't.

If someone has an extensive medical record with quite a few severe medical problems, it's easy for someone new on the scene to overlook something--whereas a doctor who knows the patient would be more likely to have a memory of those medical problems. Or know how to find the record of them.

In John's experience the hospitalist's services were useful. Not every time as I remember we switched once when he was annoyed by one. No system is perfect but the hospitalist knew how to negotiate the ins and outs of the hospital and saved us a lot of work. Whatever I asked her she found answers for, she made phone calls for us and just brought everything together in each crisis time. She also called doctor's offices when we were having trouble getting an answer to something.

I'd say she caught all those things that would have slipped through the cracks.

[Uppitycats]

I've had a hospitalist each time I was admitted. They know the hospital, know how to get things done more quickly than having orders written, waiting for each patients private physician to sign off on them. And let's face it, doctors don't have the time anymore to do hospital visits, any more than having the time to do house calls! Just as nurses do, they hand off patients to their colleagues after careful briefing, and do keep private physicians informed a what has happened with their patient. I think it's a pre effective system.

[Earth Mother 2 Angels]

((((((Hugs to All)))))) ~

I have a ton of experience with hospitalists, since my sons have been hospitalized too many times to count, typically in ICU or Step Down for anywhere from 10 to 45 days.

In ICU, we have intensivists, who follow patients during their ICU stay. This physician coordinates all of the ICU care and specialists needed. For us, the intensivist has always been a pulmonologist, as my sons were hospitalized with pneumonia (and often on a ventilator). Even when they’ve been admitted for seizures, they still have pneumonia, and the neurologist is a consultant, not the lead physician.

At some point, a hospitalist visits to familiarize her/himself with the case to ensure a smooth transition out of ICU to Step Down. My sons were sent to Step Down, because of their need for close supervision (seizures) and one on one care.

That transition has proved to be difficult many times. We are spoiled by the intensivist, who specializes in a particular discipline but is also extremely skilled in all intensive care issues. They also have a smaller number of patients than a hospitalist.

Our hospitalists have been more akin to General Practitioners, jacks of all trades, and have far too many patients with a variety of maladies to oversee.

In 2009, when Jon had all of his teeth removed at once during a 2 hour surgery, he remained in ICU for 3 days, then transferred to Step Down. The hospitalist continued to give Jon a blood thinner, even though the oral surgeon told him to discontinue it, and I repeatedly asked that it be stopped.

The result was Jon’s gums bleeding profusely, requiring a second 2 hour surgery to cauterize and sew his gums. After that, a day before his release to come home, his gum burst open, and an intensivist was called in to stop the bleeding, until the oral surgeon could arrive. Thankfully, the bleeding stopped, because the intensivist was brilliant.

But the hospitalist was a numbskull. And he was well chewed out by both the oral surgeon and the intensivist for leaving Jon on the blood thinner.

That same hospitalization, a different hospitalist was no where to be found and didn’t respond to the overhead page, when Jon began seizing, as a result of two of his antibiotics reducing his seizure med levels to nearly nothing. I told the nurse to call the intensivist, who came running from ICU and ordered IV Ativan.

Our hospital is large and state of the art, with outstanding physicians, nursing and ancillary staff. In our experience, the hospitalists are the weakest link.

We are blessed that we haven’t been there since 2012, and we know that there have been many changes. I hope one of them is better hospitalists.

Love & Light,

Rose

[Virginia]

sounds to me like it is the luck of the draw and also how busy they are. I can see where it would be advantage for your PCP or Specialist to use them, because they really do no longer have time to go to hospitals. Let's face it, the office visits are so short now because they are expected to work in more patients, that they hardly have time to do a good job see patients in their offices now.

If you get a good hospitalist it could be like getting a second opinion.

It is kind of like what happened to one of my brothers. He has had open heart surgery twice. He was hurting in his chest, went to the hospital emergency room and was told he needed a stent and he should see his regular Doctor right away. My brother did as he was told. His regular heart Doctor told him he knew that he needed it, but that it could not be done because that particular area could not be gotten to. He started hurting so bad one night he returned to emergency room where he saw the same Doctor he had seen there before. The Doctor was stunned when my brother told him his regular Doctor said a stent could not be done. The emergency room Doctor said "well maybe he can't do it, but I can". He took him in and did the stent. So I can see where sometime things can work out for the best.

As I said I guess it just depends on who you get.

[renee]

Thumbs down in general to hospitalists.

I spent this last entire winter and more, in and out of the hospital or
homebound for healing- all for dumb stuff. Scheduling hospitalists,, there was inadequate
continuity during my hospital stays. New one showed up, he nor she doesn't know me and
Did not pick up on the same track as the last doc 4 days earlier. It was unnerving.

Wow, I had one lunatic that I may have gotten put on probation. Hoorah!

[nuthatch]

Welcome back Renee, you've been missed!