Hospitalists – pros and cons

I’ve been trying to not comment on this post, but I just can’t help myself. A few months ago, I wrote to another hospitalist blogger about my thoughts on this issue.

Although I can understand the practical advantages of the “hospitalist” movement, as a patient, I’m not at all fond of it.

When someone is at their sickest, more than likely a bit frightened … is exactly when they most want to feel that they are in the hands of the person they’ve so carefully chosen for themselves as their primary care physician. They’ve developed a working relationship with their physician, and share a mutual trust and understanding – this has taken time and effort.

Being in a hospital, under the control of other people, sick, in pain, frightened, and then having to open up and be candid with someone you’ve never seen before, and trust that person completely … is a real challenge for some of us.

Our local hospital has led the way in our area – there are a half dozen hospitalists, almost all of them are foreign, and I can barely understand them when they talk.

Ever since I realized that my own physician would no longer see me when I’m admitted, I’ve stopped seeing him. The entire idea is just too threatening to me. I’ve been told that all of the physicians at my hospital are doing the same thing now, and so I’ve been considering going to a different hopsital – nearly 20 miles away … and perhaps trying to find a PCP down in that area instead … except that I have feeling that the “hospitalist” model is going to spread to all of the local hospitals now that it’s begun, so it may not be worthwhile to bother.

I believe that, under circumstances when it’s possible, patients should be given an option of whether they will accept the care of a hospitalist over their own PCP, since the patient is fully half of the equation in the physician/patient working relationship. You might be surprised how many opt out of being cared for by hospitalists when given a choice.

I feel strongly enough about this subject that I will simply not see a PCP again … since when I need him most, I now know I’m going to end up with a stranger anyway. Over the last year or more, I’ve discovered that I’m not the only one who feels that way. Most of us haven’t said anything to our physicians, we’ve just stopped seeing them.

The hospitalist model would be fine – if it were optional, not only from a physician’s perspective, but also from a patient’s perspective. It’s great for those who don’t have a PCP, or with a PCP who is on vacation … or to deal with inpatient emergencies when the PCP can’t be there. Otherwise – the patients also need to be allowed to make a choice.

In my opinion, this is just another thrust toward the depersonalization of medicine from the patient’s perspective, and it will help widen the gap in the patient/physician partnership. Continuity is destroyed, communication falters …

Good to have more eyes on patients and more opportunities to consult. Not good to leave patients in the hands of someone they do not know and do not have a relationship with. Am in southern Wisconsin, smaller community, already five hospitalists in this town’s hospital facility. The grumblings are legion. A doctor of long-standing in the community has risen up the ladder to the main hospitalist position. My father-in-law has essentially lost his primary care physician and, in the same man, now has a person who treats him quite differently. Hospital systems need to keep checking down the halls with the humans receiving care and treatment on the success of this program. Truly economic pressures and all that comes with it.