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What is the measure of a hospitalist?

A physician finds himself considering the question.

May 2017

A short time ago, I attended the funeral of an uncle who lost his battle with Alzheimer’s after years of struggle. At his funeral, my cousin eulogized his father with an eloquent response to a not-so-simple question: What is the measure of a man? He took the congregants on a brief journey through the life and times of a truly exceptional individual who had been humbled by a debilitating disease. Back in my office a few days later, I found myself considering the same question, in the context of our profession: What is the measure of a hospitalist?

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One could say a hospitalist is an inpatient provider who is an active medical staff member, or one who is neck-deep in clinical research and widely published. One might even suggest that the hospitalist in small-town America is the cornerstone not only of key hospital committees, but of the health care that is being provided to an entire community.

However you frame it, most would agree that hospitalists have now become essential in most U.S. hospitals and are being called on to solve longstanding problems that have plagued health care for decades. Even though the actual definition of a hospitalist has changed somewhat over the past 20 years, the basic principle revolves around being site-based specialists who help patients navigate hospitals’ very challenging terrain.

While some of us are involved in pre-hospital evaluations and others post-discharge care, most of us make our home within the hospital walls. All our other duties usually stem from the need for continuity of care or some related, institution-specific gap in patient care.

Not stepping up
Unfortunately, many of us have simply not answered that call in the manner we can or should. Instead, some function more like “house doctors” who show up for each shift, try to do as little as possible while watching the clock and wait for 12 hours to go by. They don’t stop to think about the system in which they work. Instead, they just intermittently complain about its various shortcomings.

Indeed, not all of us are suited to dedicating our waking hours to solving the many woes of the modern hospital. Nonetheless, all hospitalists must recognize the need to be part of the solution.

A strong skill set is certainly an absolute. As experts in the care of adult (or pediatric) patients, we must arm ourselves with a constantly evolving, up-to-date understanding of the best evidence-based practice standards.

In fact, as I travel the country as a hospitalist consultant, and interact with both large and small institutions, I rarely hear about clinical incompetence. Instead, I more commonly run into hospitalists who just simply refuse to comply with seemingly modest system requests.

One recent example: A few hospitalists refused to participate in organized handoffs at shift changes, even though they had a 24/7/365 in-house service. As one of those physicians reported, “I write excellent notes, and no one has ever complained about my documentation.” That may well be true, but the physician is missing the entire point of purposeful communication and the need to pay special attention to one of the most dangerous points in a patient’s hospitalization: transitions of care.

Even more worrisome: The absolute reluctance on the part of yet another hospitalist in another group to appreciate the need for a standard method for communicating with PCPs at discharge. This hospitalist reported being “too busy to do secretarial work.” No doubt, some of our days are challenging, and we have a tough time executing on tasks in the way we wish. But an unwillingness to recognize the importance of this responsibility is unacceptable.

Patient advocacy
Understandably, each hospitalist brings individual strengths. Some have a knack for dashboards and data, others might be great at budgets and financials. A few even have the skills to put them all together into one overall strategy.

While clinical skills are a must, the true measure of a hospitalist must start and end with patient advocacy. How can we help patients navigate this very scary environment? Hospitalist programs are in great need of such advocates, and they must institute systems that promote physician development. That means more accountability, better compensation to drive desired behaviors and, yes, better overall outcomes.

So what is the measure of a hospitalist? Much like my uncle’s, we are imperfect but engaged in a continuous pursuit to become better. Patient advocacy requires not only empathy, but also a dedication to protocols, quality of care and innovations, both in medicine and in how we practice. As hospitalists committed to “measuring up,” let us hold each other—and ourselves—accountable to being true hospitalists, not house doctors.

O'Neil J. Pyke, MDO’Neil Pyke, MD, is a practicing hospitalist with more than 17 years of hospital management and clinical experience. He is the chief medical officer for Medicus Healthcare Solutions LLC, which is based in Windham, N.H., and assistant professor of medicine at the Geisinger Commonwealth School of Medicine in Scranton, Pa. For more blogs by Dr. Pyke, click here

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Julianna Lindsey
Julianna Lindsey
April 2018 11:34 pm

Well said, Doctor. I do find it frustrating when “we” choose to not behave as professionals- we’re better than that, all of us. Fortunately most of us choose the higher ground.

Ralph Austin
Ralph Austin
May 2017 12:16 pm

I am a Family Physician and have been involved in medicine on many different levels over the past 38 years. I am back in private practice after being a full time hospitalist for seven years. I practiced in a medium-sized urban hospital in central GA. I made a very good salary (much better than in private practice), but I felt like I was contributing very little to the management of my patients’ problems. The hospitalist role was limited to admitting patients, doing daily notes, and discharge summaries. As a Family Physician, I knew the patient and could act more responsibly… Read more »

May 2017 10:48 am

Nice job O’Neil. Speaks to the issue of physician engagement.