Published in the February 2010 issue of Today’s Hospitalist
“Glorified housestaff” revisited
I completely agree with the letter from Mike Flowers, MD, in the January issue (“Glorified housestaff?“). I think it is time to promote the value of inpatient hospital physicians so that specialists “especially surgeons “don’t always get the “glory” and walk away, leaving the rest of the real work to be done by medical hospitalists.
Specialists should take on their cases, be ultimately responsible for their actions as the “attending of record” and use medical hospital physicians as consultants, when needed. This would put the responsibility of non-medical cases on the appropriate personnel.
Louis LoBalsamo, MD
The December 2009 cover story (“Are you OK taking care of this patient?,“) on admitting intracerebral hemorrhage (ICH) patients confirms a trend that I find both inevitable and concerning: our ever-expanding scope of practice.
We see an ongoing exodus of medical staff from the hospital almost everywhere we go. That leaves hospitalists, most of who are employed by or contractually obligated to the hospital, as the supposed solution. For those of us on the front lines, that’s a frightening proposition. That makes it all the more important for us to engage the administration and medical staff on these issues.
We’ll get much further with those discussions if the hospitalist program is willing to be a part of the (not the whole) solution. At one practice where I worked, we finally got the neurosurgeons at one hospital to the table, many of the reasons why they wanted us to take over ICH admissions had to do with their needing to cover several hospitals and their inability to respond emergently to an admission request for a non-surgical bleed. We were able to negotiate the following:
- The on-call neurosurgeon would speak to the ED physician and review the CT images remotely to decide if this was a non-surgical ICH. Any bleed requiring surgical intervention went directly to their service.
- If the ICH was deemed non-surgical, the hospitalist service would admit the patient “with the neurosurgeon making a consult within 12 hours.
- The neurosurgeon would round on the patient daily and be available to speak to the family daily, if needed.
- The neurosurgeon would not “sign off” until the hospitalist service agreed to that sign-off.
- The neurosurgeon would be available for a STAT, in-person evaluation at the request of the hospitalist if the patient’s condition changed.
These guidelines enabled us to forge a stronger relationship with that specialty group and, more importantly, to provide timely, efficient and safe patient care. It also provided the justification we needed for additional staffing to grow the program.
Robert Harrington Jr., MD
Editor’s note: Dr. Harrington’s comments have been excerpted from his Today’s Hospitalist blog entry. See the entire blog at www.todayshospitalist.com.