Letter: Another view of hospitalists (Nov. 5)
RE: Jim Glynn’s “Howling from the Heartland” column of Oct. 15 in which he writes about “The hospitalist: health care McDonaldized:” Although I had never heard the term before, I began to wonder if my grandson-in-law could be a hospitalist. I shall refer to him as Dr. Arthur Getwell.
I know that Dr. Getwell completed his internship at a hospital in Stockton and has been employed at a hospital on the coast for nearly two years. But what would a doctor do in a hospital, I mused, if he isn’t a surgeon? My granddaughter confirmed my suspicions. Dr. Getwell is a hospitalist.
Glynn describes a hospitalist as being a case manager who communicates with physicians, coordinates hospital modalities, and oversees the general welfare on the patient. I later learned from Arthur that Glynn’s description is pretty much true.
Where I disagree with Mr. Glynn in his description of the hospitalist’s use of medical history obtained from the primary doctor (“a hospitalist may have time to give the list only a cursory look”) and an “exit strategy.” And since Glynn’s Dr. Doom paints a rather dismal picture of the hospitalist, I wanted to get the other side of the story.
I interviewed Arthur the following weekend. I asked him to explain the steps that might be taken if a patient arrived in the ER one night and was diagnosed with a severe heart attack. How would he, Dr. Getwell, be involved?
Arthur said that after the initial care of the patient, the doctor in ER would contact him and would discuss the course of care to be given to the patient. I should imagine that when Dr. Getwell sees his patient, it might go like this:
“Good morning, Mrs. X.”
“I want to see my own doctor.”
“I just called your doctor. Dr. Caring said she can’t come over just now, but she would have your medical records faxed to me immediately. She did say that she might visit you this evening. In the meantime, I can answer any questions you might have.”
Dr. Getwell will examine the records received from Dr. Caring and then will order whatever additional tests, such as blood tests and X-rays, are necessary. He will check to see what medicines Mrs. X takes so there will be no conflict with the medication he prescribes. And if there is a medicine available at a lower cost that can effectively do the job, he will prescribe it.
Prior to Mrs. X leaving the hospital, he will discuss with her the course of action — including her medication, of course. He will see that a copy of the discharge summary that outlines the tests given, the diagnosis, and medication prescribed is faxed to her physician. He will emphasize to Mrs. X that she see Dr. Caring as soon as possible.
Arthur explained that hospitalists are available 24/7 and work 12-hour shifts. He said there is always a doctor on the premises. Dr. Getwell commented that the hospitalist’s goal is to give the patient the best care in the shortest amount of time and in a cost-saving manner.
After my discussion with Arthur, I read an article that the reference librarian at our Madera County Library found for me. It is titled “Hospitalists,” and was written by Terese Hudson Thrall for the “Hospitals & Health Networks” magazine in November 2003. The information, which I feel is still timely, is now available on the Internet.
Thrall says the program began in 1993 with the Mercy Medical Center in Springfield, Mass., using hospitalists to take care of unassigned patients from the emergency department, and later expanded to include patients from the surgical department. Included in her article were some of the following points:
– Many family practice doctors prefer to make rounds and check on their own patients; however, others have chosen not to come to the hospital. (Patient X’s doctor may not want to come to the hospital.)
– Hospitals can quickly do something about a situation as they likely have established relationships with the nursing and respiratory departments.
– Cost and length of stay may still be a factor, but improving patient safety is also important.
Personally, I would feel well cared for if I had a doctor such as my grandson, Dr. Arthur Getwell. If Mr. Glynn and other sociologists must compare a hospitalist’s patient to a Mc Donald’s patty of meat then could it be a Premium Sandwich?
Viola J. Turner,
Madera
