Published in the February 2019 issue of Today’s Hospitalist
WHILE READING the article “Tired of chasing consultants?” (December 2018), it occurred to me that we are missing a much larger point. If hospitalists practiced at the top of their license, consultation in most cases would be unnecessary, and we would not be spending time chasing them down.
In the last six months, I have found myself canceling more consults from covering teams then placing my own. I cannot begin to count the number of video EEG (VEEG) monitoring tests ordered for patients who had seizures after medication noncompliance or renal consults for medication- or hypotension-induced AKI. ID gets consulted when cultures clearly indicate a common antibiotic would suffice, and the list goes on.
While the standard should be different for advanced practice providers, the hospitalist movement should now pivot toward quality. We are valuable because we are fixed costs that decrease length of stay. If we outsource multi-organ comorbidities, we lessen our value. Instead, hospitalists should be pushed to avoid consults—and perhaps paid more for calling fewer.
~ Luis W. Dominguez, MD, MPH
REGARDING “Disaster planning: Why aren’t hospitalists at the table?” (December 2018): As a hospitalist, I have participated in several code black drills at my hospital. But I am the only one who does. Hospitalists could fill many of the gaps or even recognize where those gaps are, but I think we are seen as “too busy” to get involved in drills or planning. We may need to be more proactive about claiming a seat at the planning table instead of passively waiting to be asked at the last minute in a real-life disaster.
~ Sheryl Williams, MD