Home From The Editor Is there a time when hospitalists should just say no?

Is there a time when hospitalists should just say no?

June 2004

Published in the June/July 2004 issue of Today’s Hospitalist

When it comes to improving quality and redesigning systems of care, are there times when hospitalists should back off and leave the job to other physicians?

That question, or one like it, came up at this year’s annual meeting of the Society of Hospital Medicine. During a session on co-managing surgical patients, speakers rattled off a series of statistics about the care that surgical patients receive.

The bottom line? Because many surgeons aren’t doing a very good job of managing their patients’ medical conditions, hospitalists have a great opportunity to step in and improve the care of surgical patients.

That’s when an audience member interjected with a simple, yet pointed, question: If surgeons are doing such a poor job of caring for their patients’ general medical problems, why should hospitalists get involved? Isn’t the obvious solution to give surgeons more training on how to better care for their patients’ general medical problems?

The audience member may have been talking about surgeons, but his real point was that hospitalists shouldn’t be expected to clean up every mess in the inpatient setting. No one wants to do scut work, and hospitalists are no exception.

Hospitalists, however, occupy a unique position in health care, one that allows them to both diagnose and correct problems in the U.S. health care system. At one of the meeting’s opening speeches, James L. Reinertsen, MD, argued that this kind of opportunity is accompanied by a responsibility to take action.

As part of his standing-room-only speech, Dr. Reinertsen issued a direct challenge to the hospitalists in the audience. What, he asked, are you going to do to improve the systems at your hospital?

While he was talking specifically about ways to reduce inpatient mortality rates, his challenge echoed the concerns of the audience member at the other presentation. Just what is the role of hospitalists when it comes to reforming U.S. health care, and how much “or how little “should they do?

I’d like to hear from you with thoughts on the issue. Feel free to e-mail me.

edoyleEdward Doyle
Editor and Publisher
Today’s Hospitalist