Hospitalists: Why I don't use them

I believe in keeping up with the times. I've changed my hairstyle to an ultra-short, modern cut, and our office recently ordered some casual polo shirts bearing the name of our practice to wear under those long white coats. We have an electronic medical record, and we're thinking about giving up our pagers in favor of cell phones. But I still go to the hospital, because it's important to me. Here's why.

1 Patients like it-and expect it. In the small town where I practice with my husband and several associates, my hospitalized patients expect to see me there. I nag them incessantly to lead a healthy lifestyle, take their medications, and follow up with me regularly. When they ask why I'm so insistent, I often joke that it's because if they do these things, it will lessen the odds of me having to get out of bed to see them at 2 a.m. in the ED. That argument would lose its strength if we both knew a hospitalist would see them while I slept on in said bed, oblivious. It might even imply that I didn't really care anymore, which wouldn't be true.

My patients understand (with rare exceptions) that I'm not on call every night. They realize they might see one of my call partners initially, but they know I'll most likely be there in the morning-and every morning thereafter until they're safely back home.

2 My patients get better care. I have nothing but respect for the hospitalists in our community. They're fine physicians and they very kindly manage our ventilator patients, since not all the docs in our call group wanted that responsibility. I'll also call them in once or twice a year for assistance in critical care management if I have an unstable ICU patient who requires more time from a physician than I can reasonably give. They're happy to assist in that scenario, since there are several of them and one or two are always in the hospital at any given time. I stay on the case, though, and resume full care of the patient when office hours end or the patient is stable.

As competent and valuable to me as the hospitalists are, none of them knows my patients better than I do, both medically and personally. Not only am I more likely to know how my patients will respond to a particular medication, I'll also have an idea of how they'll respond to a diagnosis or treatment suggestion. There's a level of trust in our relationships as well, making them more likely to agree to a recommendation that might seem frightening or unpalatable coming from a stranger.

3 It improves my clinical skills. I see and manage things in a hospital setting that I don't see or manage anywhere else. I sat for my recertification test recently and couldn't imagine how much more I would have had to prepare if I didn't still have my hospital skills. It also forces me to keep current on issues. Think about how the care of acute stroke or acute coronary syndrome has changed in the past seven years!

Not only does hospital practice broaden my skills, it also gives me more variety in my day. Not much chance to get bored when I'm seeing a life-threatening pneumonia in the ICU first thing in the morning, followed by office hours devoted mostly to my fasting-patient appointments (diabetes, hypercholesterolemia, preventative exams, etc.), lunch (check on that pneumonia patient), then an afternoon of acute care issues (bumps, bruises, colds, poison ivy, etc.) and nonfasting follow-up (headaches, depression, etc.). At some point in the day I might admit someone with chest pain or an elderly patient with hyponatremia and altered mental status. Nope, not much boredom in my day.