It’s Still Hard to Understand the System

By  |  February 5, 2011 | 

A recent query to the blog from a reader states:

“Most patients of Primary Care Physicians are not aware that if their PCP is affiliated with a teaching hospital, and his doctor sends that patient to the hospital, his care will NOT be supervised by the PCP who that patient knows, trusts and know the medical history of the patient.  That patient will be cared for by a ‘Hospitalist’ a resident and perhaps 2 or more students, and this combination changes the first of every month.  This takes away from the patient his or her freedom of choice.  In spite of this most PCP do NOT tell their patients that this is the procedure if they place him in the hospital.  Don’t you think a patient has the right to know this information long before he or she is hospitalized?”

Here’s my response Sir.  I bet my colleagues have a lot more to say as well.  We are trying to help everyone through our complicated health care system…

As a practicing Hospitalist at a small hospital, and a larger referral center like that to which you refer, I understand your frustration.  The truth is that neither the patient nor the physician has as much choice or as much power over the “choices” we make in hospital care.  In fact, our ability to choose is narrowing all the time.  Meanwhile, few of the patients that we care for come to the hospital because they want to be there.  Most come in emergently for something unexpected, scary, and potentially life-threatening.

We, as Hospitalists, take our patients’ care quite seriously.  We’re working hard with our provider, nursing and administrative partners to make our model of care a more consistent, high quality, low risk framework that can be repeated by everyone throughout the country.  That which we do routinely, we will do well.  That which we do well for one patient should be done for all patients.  Ultimately, that might narrow your choices.  But hopefully, the choices offered are a few well-tested, safe, reliable care options from which to choose.

What we haven’t always done well as Hospitalists is to explain this intricate system to our patients and colleagues in offices.  When we do that, they can explain it to the patient in the office.  My practice meets with the primary providers ever few years to work on continuing to improve the quality of our communication with them and with our shared patients.  I’ve been working on that outreach just this past few weeks at my primary hospital site.  I always come back with more insight into how I can help our patients.  I enjoy doing it, and I’ll continue to do so.  The real problem comes back to use of our time, and of yours.  Your doctor probably has more patients to see than she or he can really get to in a day.  That’s true of me most days too, and I’ll just stay late to see everyone.  It’s just the way it is.

We’d love to find a more efficient way to tell patients that their doctor has likely partnered with a hospitalist system to provide their hospital care.  My practice does that through our office colleagues.  They then educate their patients on what to expect.  This has worked fairly well for our communities, but I’m open to other suggestions too.

Best Regards,
Troy W. Ahlstrom, MD, FHM


  1. […] It’s Still Hard to Understand the System 5:09 pm […]

  2. Rachel Lovins February 7, 2011 at 3:59 pm - Reply

    In addition to Troy’s excellent points above, I do think that PCP’s should let their patients know who will take care of them when they are hospitalized. I believe patients should be told in the outpatient setting (and possibly in the ED) what a hospitalist is and how the communication will work with their PCP. One thing we have done in our practice is to make brochures that explain the hospitalist service and offer these brochures to the PCP’s to put out in their office. The brochure has all the providers’ names, pictures and education on it. All doctors can get overwhelmed these days and it’s easy to forget what communication might be needed to put patients at ease. I think the simple act of handing out that brochure, both in the inpatient setting and in the inpatient setting, would make our patients feel much more comfortable. Having said that it’s easier to say than do. I think we need all the players: the outpatient docs, the inpatient nurses and the hospitalists to all do their best to educate the patients so they know what to expect, and I believe the process to educate them needs to be standardized.

    Rachel Lovins, MD
    Hospitalist Director, Waterbury Hospital

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