Hospitalists - This Patient’s Take
Usually, I like keeping the really serious stuff off from the front of my blog. I’m a persistent comment dropper … especially when I think I can sneak in a word or two on someone else’s blog … particularly if they touched upon something I’m intensely interested in. Some pretty engaging conversations can take place in comments - virtually invisible to visitors unless they stick around and do a bit of exploring. Also, I don’t mind occasionally posting something that evokes a bit a thought on my own blog … but I generally try to keep the controversial stuff off from the front page. I’m going to break that rule today.
Earlier today, I posted a comment on Dr. R. Centor’s Medrants. Yesterday, he put up a post about hospitalists, and was asking for people’s input. I’ve commented on hospitalists before … and was really drawn to doing so again - but had decided to keep my distance. When the same post was still at the top of his blog this morning, it was more than I could bear, and like a moth is drawn to a flame, I fluttered in close enough to get a whiff of singed wings.
It seemed like only a few moments after I’d finished that my Bloglines warner beeped at me, and I checked to see who had just posted … it was Dr. Centor … and here was the title: “Listen to Moof comment on the hospitalist movement.” There was my entire comment - as a post. - Oh my. Caught! Red faced. - So much for a low profile.
Once my face stopped burning, I decided that he may actually have done me a favor … the ice is broken now, so why not write what I think about issues that concern me? Why not indeed. So - here goes. Those of you who only drop in for Bean Stories and light Musings can consider yourselves forewarned …
A few years ago, I was diagnosed with a chronic illness. It’s given me some ups and downs, and for a while, it seemed as if I spent more time as an inpatient than as an outpatient. Our hospital had just started using hospitalists, and on my second time as an inpatient, I was dismayed when I only saw my own doctor once - more as a “guest” than a physician. It was not at all comfortable dealing with this new fellow who’d been dropped on me seemingly out of nowhere, even if he was very nice, and seemed to be a good doctor. I didn’t know him.
Before I continue, just a bit about myself to set the atmosphere … I’m one of those people who is not comfortable with the physician/patient venue. In fact, before my chronic illness, I had seen one in 16 years … and if I had not gotten ill, it would now be over 18 years. After I was diagnosed, and it finally got through to me that life was simply not ever going to be the same again … that I was going to have to deal with these fellows in the white coats whether I wanted to or not, I tried to put a good face on it and do my best to be a “good patient.” I hope my PCP never sees this blog … he’d probably have an aneurysm from laughing so hard. But I did try … I still try. It took some major effort on my part to even begin being candid with these people whom I don’t know. With trial and error, I found that I did better with writing than I do nose to nose … but then I still had to overcome the obstacle of letting the dear man know that I had written something. *sigh* I know that not everyone faces the same problem with being forthcoming with their physicians, but in my own case, I had to work very hard at developing some sort of relationship with my PCP … and with the other specialists which I had to see. To more or less of a degree, I’m certain that most patients have to work hard to learn to be candid about intensely personal things with people they don’t know …
You can perhaps begin to get an inkling of how difficult it would be for someone like myself - and others who have similar difficulties, and even some who don’t - to cotton to the idea of hospitalists. Yes, I can understand the logistics behind the position … it really does free up the PCP for spending more time with his patients in his office … more time with his family … and the inpatient benefits from the promptness of the medical attention/decisions they need without having to wait until their own physician can get away for his hospital run.
That said - there are some other issues to consider. I will briefly touch upon some of them, in no particular order:
And now for a few more personal/quirky considerations:
For myself - once I realized that my own physician was always going to dump me on hospitalists, I stopped seeing him, too. Although it’s been more than a year, I haven’t begun hunting for a different one, because I’m afraid that no matter who I choose, it will end up the same way. I’d rather just not see anyone than expend the effort to be intimately open with someone when he’s going to pass me over to a stranger when I need that familiarity the most.
How many of you have lost your patients after a hospital stay … and you don’t know why? Did they end up seeing a hospitalist? Did you inquire if they would have preferred to see you? That sort of attrition is going to continue - because the very people who have a hard time dealing with hospitalists are the same ones who would rather vanish from your office, and either see someone else, or no one at all, than confront you. And if they don’t leave, has the trust between you been damaged? Have you asked how they felt about hospitalists? In fact, have any of you even considered asking patients their opinion on such a thing - considering they’re the ones who are going to be forced to deal with the experience?
Medicine is becoming so impersonal … from the point of view of a patient with a chronic illness, that’s pretty scary/uncomfortable/nightmarish. Hospitalists themselves are not the problem … I think that having doctors who are hospital based is a good thing … but I think that if ever a primary physician willingly turns the full care of his hospitalized patient over to another physician, then he needs to ensure that the patient isn’t lying through his teeth about how he feels just so he can get out of the hospital and away from a situation he may find is even more uncomfortable than his medical problem.
If I’m cultivating a relationship with a dear friend, and the minute I have a problem which calls for a shoulder to cry on, that friend fends me off on someone else they know (It’s ok! They have a lot of experience at being friends!) any previous trust engendered by the relationship is going to plummet.
Some of your patients don’t just see you as white jackets. Some of us see you as people - and we learn to relate to you as individuals. We are not just seeing you as what you are, we are also seeing you as who you are, and that part can’t be substituted by just any other white coat.
On a Roll:
A Long Time Coming:
To Be ... Or Not To Be ...:
Sneeze/Nausea Connection - March 2007 Update: