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The 40-year-old hospitalist

July 2011

Published in the July 2011 issue of Today’s Hospitalist

A FAVORITE MOVIE is The 40 Year Old Virgin” starring Steve Carrell. It is a hilarious take on the socially challenged lead character who somehow makes it to the ripe age of 40 without consummating any relationship with a woman. Of course, during the course of the movie, our virginal friend ends his dry spell, which may explain why there was no sequel. Apparently, there is nothing funny about a 40-year-old non-virgin, no offense to those who have chosen a chaste life.

Like Mr. Carrell’s character, I am now 40 years old; unlike him, I am a hospitalist. (Just to be clear that there are other dissimilarities: I have a son.) It is at 40 that one begins to spend way too much time thinking about what one’s own sequel may hold. For the reader’s sake, I’ll narrow my excessive angst to only those things that are hospitalist related. Not interested, you say? Well, have some respect for your elders!

Professional resident?
Obviously, a lot has changed since I began practicing, and it has been very exciting to have been part of this revolution. My professional “introduction” to hospital medicine dates to 2000, when a nephrologist approached me in the doctor’s lounge during my first week as an employed hospitalist.

Instead of extending a friendly welcome to the hospital, he berated me about what a terrible decision I had made. “Why would anyone choose to be a professional resident?” He ended his tirade with these encouraging words: “It is not too late to return to fellowship.”

Who knew that more than 10 years later ours would become the fastest growing medical specialty and that I would count nearly 40,000 other doctors as my colleagues? And who knew that I would be routinely receiving CVs from nephrologists who either can’t find jobs in any remotely urban area or who are looking for a position that doesn’t have them on call every third night and covering three hospitals every weekend?

Cutting waste
Of course, the misery of a few nephrologists is no way to gain personal satisfaction or even insight, and shouldn’t be gloated about in print. No, this has been a great career because it has allowed me to put into practice several attributes that define my character. Here are the big three, assuming that I can remember them for five minutes in my newly acquired geriatric state.

No. 1: I care about waste. It literally drives me nuts when a useless test or intervention is performed. I have cancelled many of these tests and procedures after having an open dialogue with patients and subspecialists.

I am amazed at how cost effective a conversation that includes “How will this affect one’s comfort or prognosis?” can be. And don’t get me started on the unneeded consults that drive so many of those unnecessary tests and procedures. If health care reform gets some teeth, I believe all of us will count waste reduction as a central part of our jobs. That means that I will not only get to save patients, but also play no small part in protecting the long-term sustainability of health care delivery.

Two, I value my time and health, and so does hospital medicine. This is a specialty that allows us to balance dedication to a career with the knowledge that you live only once. Eighty-hour workweeks followed by more 80-hour workweeks would have left me on my proverbial deathbed, regretting that I did not spend more time with my family and doing the other things that make me healthy in mind and body. After a career as a hospitalist, I hope that my last few moments ” especially if I spend them in one of those new “Sleep Number” beds, I hear they are very comfortable “will be passed in serene reflection, with little remorse over those things I was too busy to experience.

Gaining patients’ trust
But mostly, I value the ability to forge a brief but intense relationship with patients and their families. The most powerful thing about my job has been creating the kind of trust that facilitates meaningful conversations with people who were perfect strangers only 10 minutes earlier.

What a great honor it has been to help a couple who’ve been together 50 years decide that it is time for one of them to pursue comfort care. And I will never get tired of hearing that what I say makes sense, they “get it,” and now feel comfortable with the direction of care we have jointly decided to pursue.

Make no mistake: Looking forward to life as the 40-year-old hospitalist comes with a new perspective. How could it not, given that it has been at least three years since the last patient said: “You look like that guy on ‘ER!’ ” No, I never did look like Noah Wyle (better known as the charismatic Carter), but I was young once, and apparently cataract surgery has been perfected only recently.

But in all seriousness, I do believe that age has brought an even greater appreciation for what I do. So, I guess I am happy to be the 40-year-old hospitalist. If the first act is anything like the sequel, and boy, I do hope there is a sequel, then things should be just fine.

Erik DeLue, MD, MBA, is medical director of the hospitalist program at Virtua Memorial in Mt. Holly, N.J. Check out Dr. DeLue’s blog and others here