Hospital Conversations

John Nelson writes…

Don’t you sometimes get a kick out of the conversations you overhear in a hospital? I’ve been a hospitalist for over 20 years, and I still find it interesting to listen to the way care givers talk with patients about all kinds of things. For example, I still hear some doctors and nurses tell patients that if they leave against medical advice their insurance will not cover their bill. As far as I’m aware this isn’t the case anywhere. (Please let me know if I’m wrong about this!)

A conversation I’ve overheard countless times is when an ED doctor or nurse explains to a patient that they have asked a hospitalist to see the patient for possible admission. So often the conversation goes something like “It looks like you’ve got pneumonia. Your PCP doesn’t come to the hospital anymore, so I’ve called one of our hospital doctors to admit you.”

I see two problems with this. The first is that the ED doctor or nurse nearly always tell a patient they’ve called the hospitalist to admit the patient. In cases where there is no doubt about the need for admission then it is nice to the patient/family for the ED doctor to go ahead and let them know they will be staying. But sometimes I arrive and find additional information that suggests admission isn’t necessary, yet the patient is often unable or unwilling to go home (understandably) since the ED doctor said admission was required. I’d prefer that if there is any chance admission may not be required that the ED docs would say something like “It can be tricky to decide whether it is best to treat your pneumonia in the hospital so I’m going to ask for another opinion from Dr. Smith (the hospitalist).

The other problem is that the ED staff is typically providing the patient’s first introduction to the hospitalist, and says things that make it sound to the patient like they’ve been abandoned by their usual PCP and they’re getting the generic house doctor who doesn’t have anything else to do. The patient probably arrived at the hospital hoping to see their PCP or a super doctor who is the best around. And the ED staff may convey a different impression. It is like the patient has arrived at a fancy restaurant only to be told they’ll be getting the generic house wine instead of the really fancy stuff other people are getting.

When patients ask floor nurse “who is taking care of my mom?”, the nurse, who may have a high regard for the hospitalist, sometimes says things that make the hospitalist sound like a resident or other type of “junior” doctor or “doctor-lite.”

So I suggest hospitalists consider providing ED doctors, and nurses throughout the hospital with a really simple script to use when introducing the individual hospitalist and describing the concept of what a hospitalist is. It could go something like this:

Your doctor (PCP) has decided to focus her practice on the office to be more available to you there. As a result, she has decided to refer you to Dr. McCartney who is a doctor that specializes in the care of hospitalized patients with problems like yours. Dr. McCartney will communicate with your PCP, and you should plan to follow up with her when you are discharged.

Of course, the hospitalist should introduce herself in a similar way, and provide a brochure that describes the hospitalist practice. All of these things should increase the patient’s confidence in the hospitalist, and ultimately their satisfaction with their hospitalization.