One More For the Hospitalists

Paul Levy

Posted 3/5/12 on Not Running a Hospital

Several weeks ago, I asked, “How do we feel about hospitalists?”  I expressed my rather enthusiastic support for these hospital-based internists, as I have worked with many of them and found them to be attentive, patient- and family-centered, and highly focused on process improvement.  Some people who commented felt differently.

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“Hospitalists Don’t Do It Like We Do. We’re Better.”

Bradley Flansbaum

Posted 2/13/12 on the Hospitalist Leader

How often do we hear declarative statements rooted in dogma, propagated over decades?  Countless times, physicians providing continuity care for chronically ill patients “assume” that by the very nature of that continuity, they outperform doctors not in that station, especially as it relates to intimate tasks.  “Hospitalists are ill equipped to obtain advanced directives; they don’t know the patient like I do,” or something to that effect.

That may be the case, but I suspect community docs are not completing the mission.  This is not a spiteful statement, but an observation rooted in experience and evidence.

The system is broke, and while I am sure community docs do know their patients thoroughly, that is not the focus of my post.  What is is that same intimacy and whether a physician penetrates it to achieve a consequential end—in this case a “break glass in case of emergency” portfolio.  That takes time and emotional energy, and both are in short supply.  As doctors, we are all men amongst equals in that domain.

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Green House-ists

Bradley Flansbaum

Posted 11/06/11 on The Hospitalist Leader

The August study in The Annals of Internal Medicine assessing global costs of hospitalist care both inside the hospital, and subsequent to discharge initiated reflections within our ranks.  It was also prominent in the lay press (“Are hospital-based doctors fueling health spending?“).

I found the data credible, and the conclusions that questioned our efficiency authentic.

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Twenty-Four Seven

Bradley Flansbaum

First posted 8/07/11 on The Hospitalist Leader

Two recent articles, one from The New York Times, the other from The Hospitalist,initiated some 24/7 staffing issue rumination on my behalf.  It stems originally from a recent op-ed by Lucian Leape:

“Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education contingent on hospitals’ limiting work hours. We can’t afford to wait another 40 years.”

How do the aforementioned pieces resonate with the above quote?

The NYT article, well written, examines pediatric training, errors that stem from doctor “fatigue,” and the root causes behind these errors—presumably due to burdensome hours and the legacy of educational norms of decades past.  The author, chief of pediatric cardiology at UMass Medical School, cites the evidence before and after implementation of trainee work hour restrictions in 2003 (not overwhelmingly positive incidentally), and concludes that it may not be the stretch worked—although this is a factor, but how information is communicated doc to doc, and shift to shift.  This is not news to hospitalists.

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