Published in the June 2015 issue of Today’s Hospitalist
I enjoyed your recent cover story on the role of primary care physicians in acute hospitalizations (“Could you drag PCPs back to the hospital?,” April, page 24). I spent the first seven years of my career as a traditional internist and have been a full-time hospitalist for the past 11 years.
I greatly enjoy my work in acute and critical care, and I appreciate the good things the hospitalist model has brought to our health care system: 24-hour physician availability, better throughput and length of stay, standardized care and clinical teaching, all of which are very good for patients. Plus, a more predictable schedule that is good for physicians.
But over my career, I have watched the hospitalist movement and read the hospitalist literature with concern. The current system isolates patients from their primary care physicians precisely when patients need them most. The most immediate unintended consequence is a loss of clinical information: a patient’s cognitive reaction to illness, psychosocial data such as family dynamics, hidden substance abuse, an ability or willingness to be medically compliant, and end-of-life care wishes. When primary care physicians have no direct role in hospital care, all that insight is lost.
I believe the time has come to modify our current hospital care model and bring primary care physicians back to the hospital as consultants to enhance the care hospitalists deliver. Such a consulting role needs to be manageable and sustainable for both primary care doctors and hospitalists with the overarching goal of more efficient, cost-effective and compassionate care.
James J. Cappola III, MD