We are hospitalists, not glorified residents

Three misconceptions cleared.

Hospital medicine is a young field. Introduced as a general medical inpatient service, hospital medicine has seen tremendous growth since its birth. The hospitalist service at King’s Daughters Medical Center (KDMC) is just one example. The Ashland, Ky.-based facility houses an established hospitalist service. The program began in 2004 with one provider. Over the past eight years, it’s brought on a team of hospitalists, an office coordinator and a follow-up care coordinator.

ThoughAshlandis a small community, KDMC serves a large geographical area, extending intoOhioandWest Virginia. The hospitalist service is the largest in the region, medical director of the program Sam Adams said.

Adams, along with Jackie Deems, director of inpatient physician practice, have witnessed the growth the program. The two describe the program as a mature one, but haven’t forgotten what it took to get to this point. Being in a young field, there’s been some misunderstanding of who hospitalists are and what they do. There also seems to be recurring misunderstandings between hospitalists and others no matter where they work.

Three Misconceptions
1. Hospitalists work with patients outside of hospitals.
At their title implies hospitalists work in hospitals. They can be found in other healthcare facilities such as nursing homes, but one factor remains constant: Their services do not go beyond the walls of the building.

Most primary care physicians, specialists and other inpatient services understand that. Deems said confusion seems to be with home health agencies, infusion therapies and other outpatient services.

“One of the biggest misconceptions we deal with is the therapy services understanding that hospitalist’ services are just that – in the hospital,” she said. “The understanding of the role of the hospitalists versus the role of the primary care doctor [is] our biggest opportunity for education in the community.”

To overcome any misunderstanding, Adam meets with providers to clarify roles and duties and hopefully forge new relationships. The follow-up care coordinator serves as an additional resource to make sure all needs are met when a patient leaves the hospital.

2. Hospitalists want to steal patients.
The relationship between hospitalists and primary care physicians has come a long way. In the younger days of hospital medicine, some PCPs were hesitant to refer patients to hospitalists; others felt resentful.
“Some misconceptions are that that we [were] here to steal their patients,” Adams said. “We have no benefit to steal their patients. We manage the patients that come into our services and return them to their primary care physicians.”
Though primary care physicians send their patients to hospitalists, so do specialists. The hospital administers patients from surgeons, cardiologists, oncologists, hematologists and more, Adams said.
“[Primary care physicians] can focus their time and energy on their office practice, and specialists can focus their time on procedures, and they’re happy to have hospitalists take care of their patients,” Deems said. “It’s a benefit to them and a benefit to the patient.”

3. Hospitalists are glorified residents.
Small facilities may be able to get away with not having a hospitalist team, Adams said, but larger ones may find it difficult. Deems and Adams agreed that hospitalists have become such an integral part of KDMC that the facility would likely struggle without the program. Deems estimated that KDMC’s hospitalists see about 40 percent of the patients on any given day.

“Hospitalists are very skilled at taking care of hospitalized patients because they do [this] every day,” Deems said. “They’re very efficient at it—the ordering of tests, working with departments within the hospital—because they’re physically here all day. They just have those connections that are little more difficult for the outlying doctors.”

Adams added that these physicians are often up-to-date on the acute care and inpatient management along with the latest information on treatments.

Hospitalist-Patient Relationship
Before the Supreme Court ruled the Affordable Care Act constitutional, Adams said that the way medicine is practiced is going to have to change. Hospitalists are no exception. He explained that care providers have to become more efficient while remembering to focus on the value for the patient.

Building a relationship with a patient is more difficult for a hospitalist than a PCP. When patients come to see them, they’re usually at the sickest point of their lives. The team at KDMC looks out for them in their own way. They serve on committees and involve themselves in the decision making process.

Likewise, patients are growing to understand who hospitalists are and what they do. Simply put, hospitalists are physicians devoted to providing inpatient care in a hospital. They ensure that the patient remains a top priority.

by Chelsea Nichols 


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