Published in the September 2009 issue of Today’s Hospitalist
How much do your patients understand about the care they receive in the hospital “and your role as a hospitalist?
Earlier this year, the Archives of Internal Medicine published a research letter that found that 75% of patients who had spent some time in a large teaching hospital couldn’t name a single inpatient physician who had been in charge of their care. Of the 25% who produced the name of one physician, most were wrong.
Overall, researchers found that only about 4% of patients could correctly identify a physician by name. That was despite the fact that most patients rated their understanding of the roles of their physicians as “very good” or “excellent.”
The study raised questions not only about how well patients bond with hospitalists, but about how well patients understand the process of inpatient care and how good of a job physicians are doing communicating with patients. The authors of the study, for example, conjectured that if patients can’t name a physician who cared for them in the hospital, they may be less informed about important aspects of their care, including who to direct questions to both in the hospital and post-discharge.
To find out how hospitalists try to help patients understand the role that they play, we asked physicians in four different practices how they introduce themselves and communicate.
Leading with the name of the PCP
“I use the term ‘hospital doctor.’ “
“Joseph Li, MD Beth Israel Deaconess Medical Center
When Joseph Li, MD, explains his role as a hospitalist to patients, he goes to great pains to stress that he is working hand in hand with the patient’s primary care physician.
“Patients have relationships with PCPs for decades,” says Dr. Li, who is director of Boston’s Beth Israel Deaconess Medical Center hospitalist program. “Then, at the sickest time of their lives, they end up in the hospital and someone like me shows up. They’re left wondering where their PCP is.”
To allay any anxiety that patients have “and to help explain the role of hospitalists ” Dr. Li makes sure to mention not his name, but the primary care physician’s five or six times in the first minute or two that he meets patients. He also avoids using the term “hospitalist” because it takes too much time to explain.
“I use the term ‘hospital doctor,’ ” Dr. Li explains, “because most people understand what an ER doctor is. I explain that I take care of hospital patients only, which gets me over that hurdle. I also tell them that if they or their family members ever have any questions about their care, they should feel free to ask me.”
Does he think it matters whether patients can remember the name of the hospitalist who cared for them? The answer is “yes.”
That’s particularly true in busy teaching hospitals where so many providers come and go. Patients need to be able to identify a physician, like a hospitalist, who has a more regular presence than other specialists.
Dr. Li says that he makes sure to write his name on the white board by the patient’s bed and to give patients his business card. “I would hope that people would remember me,” Dr. Li says,” and that would be a reflection of the level of care they thought I was providing.”
He notes that such recognition could bring other benefits. From a legal standpoint, it may provide protection from lawsuits. Extensive research has shown that patients who like their physician or have a relationship with him or her are less likely to sue.
Besides, Dr. Li adds, with everyone from payers to hospitals scrutinizing patient satisfaction scores, name recognition can only help hospitalists.
Better name recall
“Patients who can identify their hospitalist have a point person to refer to.”
“Manoj K. Mathew, MD HealthCare Partners
To help patients understand his role “and possibly remember his name “Manoj K. Mathew, MD, also likes to emphasize his relationship with their primary care physician. Because he works for a large multispecialty group that employs both hospitalists and primary care physicians, he has a big advantage in that he actually knows many of his patients’ PCPs.
“We are very familiar with the group physicians because we interact with them routinely at clinical meetings, so we see them face to face,” says Dr. Mathew, who is lead hospitalist for HealthCare Partners, an integrated health system based in Los Angeles. “When you have direct interaction with people, there’s a better comfort level.”
Emphasizing that same-group connection not only reassures patients, but it also helps address another concern: whether the patient’s insurance will pay for the hospitalist’s services. Dr. Mathew says that gives him a chance to further explain that he is part of the same group as the patient’s primary care physician, so everything will be covered.
But not every patient he sees is from the HealthCare Partners network. Dr. Mathew’s service also accepts referrals from physicians in an IPA network who he doesn’t necessarily know.
With those patients, he also explains that he’ll work closely with their outpatient physician, but he might broaden the conversation a bit. “I focus on the fact that I specialize in hospital medicine,” Dr. Mathew explains, “and that I act as a primary in the hospital. If I say I’m an internal medicine physician specializing in hospital medicine, it gives me more credibility with patients and reduces their anxiety about not seeing their primary care physician.”
With all of his patients, he spells out what will happen throughout their visit so they have a clear understanding of the process, and his role in it. He tells patients, for example, that he’ll create a discharge summary and will call the patient’s primary physician to discuss the hospital visit. “One frequent question I hear is, ‘Will my doctor know what is going on?,’ ” Dr. Mathew says. “Talking about a discharge summary gives patients the feeling that there’s a sense of continuity.”
As to whether it’s important that patients be able to name the hospitalist who treated them, Dr. Mathew argues that the answer is “yes” for a very practical reason: Patients know who to call with questions, or at the very least they can tell their outpatient physician who cared for them.
“It’s beneficial in the long run because patients who can identify their hospitalist have a point person to refer to if they have questions or problems,” Dr. Mathew says. “As hospitalists, we are the bridge. The specialists may not be talking to each other, so the best person to provide an overview is the hospitalist.”
As for helping patients remember his name, “I’m Indian, so many patients are surprised when they hear my last name and check to make sure they heard it right,” Dr. Mathew says. “Because I work at a Catholic hospital, I sometimes answer, ‘Yeah, like Mark, John and Luke …’ I usually get a smile “and better recall of my name and face.”
Get family members and nurses involved
“The name is secondary.”
“Julia Wright, MD University of Wisconsin School of Medicine and Public Health
Julia Wright, MD, likewise introduces herself to patients by emphasizing her relationship with their outpatient physician, in part because so few patients understand the concept of hospital medicine. “I use the term ‘hospitalist’ if patients are familiar with it,” she says, “but I tend to explain that I’m an internist who focuses on the inpatient part of care by working with their physician.”
Dr. Wright, who is professor of medicine and head of the section of hospital medicine at the University of Wisconsin School of Medicine and Public Health in Madison, Wisc., says that one key to both explaining the concept of hospital medicine and establishing her own personal identity is to get family members involved.
“It helps round out the information for the patient,” she explains, “and it helps coordinate follow-up care so everyone knows what their role is. Patients take in a lot of information at the hospital at a time when they’re sick and stressed and scared, so even simple things like the physician’s name are lost in the mix. But having other people in the room with patients can help reinforce that.”
Dr. Wright says that she uses handoffs as another opportunity to help patients understand their care “and help them recognize hospitalists as part of that system. Fairly early in their stay, she explains that there will be some handoffs among hospitalists. She also makes sure she tells patients when another hospitalist is going to assume care.
“I’ll tell patients that my partner, Dr. X, is going to take over,” Dr. Wright says, “and that she’ll be here at about the same time in the morning. I explain that she’ll also be in contact with your PCP, so nothing will be lost.”
When asked if it matters whether patients remember the name of the hospitalist who treated them, Dr. Wright gives a firm “yes.” For one, not knowing your doctor’s name “or not being able to tell a hospitalist from a cardiologist “can affect patient satisfaction surveys. “They’re going to describe the doctor they first think of,” she says, “so it’s helpful that they know who I am.”
She also suggests harnessing another valuable resource in establishing her identify and relationship to patients: nurses. “Other members of the health care team can help share identifying information about the hospitalist in charge with patients and families,” Dr. Wright points out. “The nursing staff often take ownership of the patient’s care and can really facilitate the exchange of that information.”
But ultimately, she says, what’s more important than patients knowing her name “or the name of other hospitalists “is that patients think they received good care in the hospital. “To me,” Dr. Wright says, “the name is secondary.”
“A role clarification is an important part of introductions.”
“David Frenz, MD HealthEast Care System
When it comes to improving patient-doctor communications, HealthEast Care System in St. Paul, Minn., is taking a hard look at how its providers talk about themselves “and their colleagues “to patients.
When hospitalists first meet patients, they produce a brochure that contains their name, specialty and a photo. But once hospitalists get beyond that initial introduction, they’re being asked to view patient interactions in an entirely new light.
David Frenz, MD, a hospitalist at HealthEast, says that the health system has been working with a consultant who is advising providers to “manage up” their interactions with patients. Whenever patients are going to see another physician or interact with another department in the hospital, physicians or nurses are supposed to give a little information about that upcoming interaction.
If you’re sending a patient for a consult with a nephrologist, for example, you’re supposed to explain what you expect to happen during that consult and give the physician’s name and qualifications. If you’re a nocturnist who admits a patient and you’re about to go home, you’re supposed to tell the patient about the hospitalist who will take over and talk up his or her abilities as a physician.
Dr. Frenz puts it this way: “It looks better if you can tell Mrs. Jones, who was admitted acutely for a broken hip, that you’re going home at 7 in the morning, but that your partner Dr. Frink is going to assume her care, as opposed to simply disappearing.”
Nurses are supposed to do likewise for other nurses, physicians or even entire departments. (“I see you have an echocardiogram in the morning. Let me tell you a little about the procedure and the person who will be performing it.”)
Dr. Frenz says that when he first heard about the concept, he was skeptical. “This is the Midwest,” he says, “and we’re modest.” But he’s had a change of heart, in part because he thinks that “managing up” makes patients feel more comfortable with the care they receive.
“So many patients see physicians from more than one specialty,” Dr. Frenz says, “and it’s often not clear what our various roles are, so I think role clarification is an important part of introductions.” Far from feeling that the method introduces too many names, Dr. Frenz points out that in managing shift or department transitions, he’s not rattling off a half dozen names.
The names he does mention always come with some identification and qualifications, such as, “Dr. Synhavsky is a kidney doctor who has practiced here for many years and is very well regarded.”
Dr. Frenz also has a slightly different perspective because he serves as medical director for addiction medicine. A detailed patient introduction can help him set the agenda with patients who have drug and alcohol problems.
“A lot of times, I’m consulted to see patients who are in denial about their alcohol and drug problems,” Dr. Frenz explains. “A carefully crafted introduction goes a long way toward addressing that.”
While the notion of “managing up” is relatively new, Dr. Frenz says there are some initial signs that patient satisfaction scores are improving. And when asked if it’s important that patients remember his name, he says he’s not sure.
He recently saw a patient in a clinic who had undergone knee replacement six months before and couldn’t remember the name of the surgeon. “That’s probably a good thing,” Dr. Frenz says, “because it was an uncomplicated surgery.”
Edward Doyle is Editor of Today’s Hospitalist.