As my father continues to be in the hospital, it gives me the opportunity to live the things that happen to other families and patients. I think that many physicians believe that they understand what their patients go through. I imagine that many have real empathy for what patients go through. But there is nothing like having someone you care about in a hospital and not doing well. You ask for information and the nurses try and tell families things to comfort them, but too often that information is just not true. My poor mother tells me things that the nurses told her that are absolute nonsense. It may have been well meaning, but it was not at all true.
Then there is the issue of communication between teams. When I was in training there was not a specialty called Hospitalist. Patients in the hospital were cared for by their own physicians, or the colleagues of their physician. For those that didn’t have a primary doctor, there were on call physicians that would take them. If you were in an academic hospital, a lot of the care would be delivered by doctors in training with some oversight from a fully trained doctor. This system had pros and cons, but the one thing I knew was that if you were being taken care of by a physician who knew you well, you got good care. It was care delivered by YOUR doctor. But it is also true that YOUR doctor has other things to do during the day. They have clinics to run and if they have many patients that are the hospital to see, you might imagine that it is too much for them to manage both their normal clinic as well as increasingly complicated patients who are in the hospital.
So, all of a sudden we had hospitalists. These folks take care of patients who are admitted to the hospital and do not take care patients over the long-term. The good thing is that they are there all the time. The not good thing is that they might not always feel any ownership for the patients in the hospital. They don’t have an emotional connection to patients. So I sometimes have felt that they view their week on as a job and when the week is over, they are done. Perhaps they feel that their success is in the one week they spend with patients, but then fail to understand that success is actually defined by the patient and their family rather than one week at a time. But I wonder if they know that? Because sometimes it certainly does not feel that way. In my experience, the effort in making good handovers to a new team is lacking. And that results in less than optimal care for patients and families if they spend more than one week in the hospital.
To be fair, the research that I found on the impact of hospitalists suggests that they reduce the length of stay for patients without causing harm. So from a population health aspect this specialty appears to be helping patients. I hope this is the case for others, because that is not what my family has experienced. Families should not be the source of continuity and history for their family members in the hospital. This is the responsibility of providers and I think they can do better.