Robert Chang writes…
In the academic hospitalist world, we’re still in the midst of what is essentially a cultural revolution with significant practical implications. The continued changes to healthcare and the increasing fraction of work falling to the hospitalist workforce are accompanied by tensions along the multiple interfaces with nursing staff, our colleagues, residents and administration. After writing my last post, I realized that it may be helpful to give a window into the academic world and the particulars of how I have chosen to prioritize relationships over problems (or failed to do so). I trust that my experience will not be universally true – hopefully fragments of the story are familiar and help define the issue more clearly whereas other fragments are illuminating due to their contrast with the reality at your institution.
This post will primarily serve as an outline for things to come.
I’ll start with a progression of assertions about how we arrived at the current state of care provided in my health-care system:
a. it is difficult to distinguish our role from a resident’s from the type of work that we do, both for physician and non-physicians
b. much of what is handled by non-physician staff in the community is managed differently in academia (e.g. physician paging, phlebotomy and NGT) – that care is often distributed to the residents
c. the issues that residents traditionally managed without complaint in point b (or at least without voice for the complaint) are now distributed to attending physicians who do complain (sometimes a lot)
d. conflict ensues – between individual physicians and nurses, which breeds a general mistrust and divisions along much broader lines
This is an example of a relatively confrontational view about a fraction of the academic hospitalist world. Without letting go of this understanding, since there is some measure of truth to it and it allows us to see why conflicts ensues, we also have a chance to remodel the system and how we chose to act in it. My last post was a microcosm of the division lines that exist and this brand-new opportunity to redeem the ways of old – in the sequence above, the opportunity would be to recognize the common goals that nursing and physicians have and yet that we each have a particular role to play in achieving those goals.
So, in the next several posts, I’d like to look at the dynamics of the following topics and how to move through them in the academic arena:
a. the love-hate relationship between medicine consultants and primary hospitalists
b. the unclear path of promotion for clinical physicians in our institution
c. the joys (yes, joys) of administrating and leading the group I am part of
d. resident and attending interactions
e. where to go with the history of nursing, residents and the introduction of hospitalists