Home Blog Enough already?

Enough already?

September 2010

I see two ways to respond to the editorial by Dr. Beckman in the Annals of Internal Medicine.

The editorial is critical of hospitalists for a variety of reasons that may be best summed up as the “usual suspects.” Option No. 1: It can be a rallying call to improve process and outcome. In fact, Jeff Glasheen deftly does just that in a recent The Hospitalist editorial, challenging us to communicate more effectively with our outpatient colleagues..

Then there’s the second option, one that I am more inclined to use: complete indifference.

We have heard all the criticism, so at what point do we just smile and give the look? What look, you say? It’s that smirk I keep giving my son, now that he is just week or two removed from his second birthday.

Every morning since that glorious day, he wakes up looking for another birthday present. For the first few days, I tried to reason with him, “No, it is no longer your birthday, you don’t get a present just for waking up.” By day 10, I simply smile and give him that look that I am sure he will someday give me when he’s a teenager and I ask him to be home by 10.

The etiology of the current criticism started day 1 of the hospitalist movement. Way back then, it was largely uttered by physicians who declined a seat on the growing bandwagon and chose to continue to practice inpatient medicine.

You may not have agreed with their decision to fly into the hospital at 6:30 a.m., often leaving in their wake a slew of consultants to disjointedly manage the case for the rest of the day. But you did respect them for sticking to their conviction that the care they provided was better for their patients. And for those who still maintain an office and round, despite worsening reimbursement and increasing hospital pressure to wholly align with the institute’s interests (in spite of the inherent personal financial disinterest in doing so)–again, more power to you.

But for doctors who criticize hospitalists while utilizing hospitalists, really, enough is enough. If you don’t like something, rather than pen disgruntled essays about a failed state, why not opt out? Last I checked, hospital medicine is not mandatory. Another option: We are also always looking for good hospitalists who can improve the field, so if you can’t beat them, why not join them? If neither of these scenarios is in your cards, it might be more productive to sit down with your hospitalist group and work to improve relations as a partner in the process.

I recently dealt with a primary doctor who was happy with the care we provided but thought we could do a better job communicating with her. No doubt she was correct. Her solution: Stop by, and make sure every doctor had her cell phone number. I also worked with her to make sure her patients were tagged with a reminder in our system, telling doctors to call her with everything major seven days a week.

Back to Dr. Glasheen, who called for a telethon of communication: “For one week, join me in committing to calling 100% of the available PCPs on patient discharge. I can guarantee you this will prove to be a hard, time-consuming, and, at times, migraine-inducing process.” He is of course absolutely on target. Our group is guilty of communication oscillation. We rally and become more meticulous about calling, and then we can get complacent. Reminding everyone to communicate in the middle of a busy week is the role of any good hospitalist who cares about his or her program.

But what I found to be equally important is learning who needs what. Some docs simply don’t want the real-time notification because it interrupts their care of office patients. If I were in primary care where distractions abound, I too would want to limit external noise to focus on the patient in front of me. Other primaries want to be fully in the loop. Great, and that is the level of service we will always strive to provide.

I won’t apologize for feeling that the Annals essay was essentially that of the proverbial “grumpy old man.” Yes, we can learn from it, and we are far from a perfect system. But at this point, we are the closest thing to a solution that health care has going for it. With the potential alignment of financial interests under health care reform, we stand to become even more vital in simultaneously and synergistically merging better quality with cost containment.

If physicians want to be critical of the system, have at it; after all, I have no intention of stifling my son’s urge to ask for one more present. I just hope criticism comes with measured attempts to improve the system. We are all in this together, and we all want the same thing: outstanding care for our patients. But if at the end of the day, you feel like a better doctor by criticizing hospital medicine–excuse me if I am no longer listening.