Who Is Driving the Bus?

You are a hospitalist. Like all hospitalists, you struggle with the pace, the hours, the complexity of demands placed upon your clinical time, the dratted medical record, burnout. You sometimes feel the collaborative process with your consulting colleagues could be improved. You often feel that you are treated like a “glorified resident”, with consultants, or others, dictating the care to you. You resent that is seems you are there only to admit or discharge or cover the less appealing weekend and holiday shifts.

These feelings are legitimate. They are also common.

But allow me to ask: Are you driving the care? Are you owning the hospital space? Are you reaching out to communicate with your consultants? Are you discussing the case? Are you driving the bus? Because as a hospitalist, you can’t have it both ways. You can’t complain that you aren’t treated with the respect that I know your expertise deserves if you really don’t own the arc of the hospitalization.

What does owning this look like? It means that you own the decisions. That when consultants make recommendations, you realize that they may be seeing things from a particular perspective, which adds value, but that perspective may not allow the entire picture to be visualized. You interpret all recommendations and plans in the larger sphere of not only this hospitalization, but for this patient overall. You know the patient’s insurance status, their ability to get to appointments, their social support, their health literacy. You know what is possible and what is untenable. But if you simply do what you are told on every occasion without critical thought or input, you are not driving the care. You are sitting in the back of the bus. And when that happens, who is driving?

When you become a passenger in the bus, you don’t control your own destiny or your own day. You won’t be regarded with the high level of respect you deserve. You won’t gain the trust of your patients and their families. You also won’t feel satisfied; presumably, you chose hospital medicine because you were attracted to the challenging but finite space of the hospitalized patient and to solving the physical and metaphysical problems of inpatients. You are the keeper of this kingdom.

Get in front. Grab the wheel. Start driving. Get happy.