When you train in internal medicine, you learn the concept that your profession is your vocation. Internists care for their patients from age 18 to his or her passing. Whether it’s an ingrown toenail or septic shock, you go the distance with the patient and their family.
Medical advances have helped us take care of certain conditions better. And that means a new cohort of older patients taking a lot of medications and living a quality of life their organs could not have sustained twenty years ago.
In 1988, Dr. Robert Wachter, a professor and associate chair of the department of medicine at the University of California, San Francisco published an article in the New England Journal of Medicine acknowledging this new patient group was creating a distinction between the care given an outpatient and the care that needed to happen for an acute medical problem. He proposed a separate specialty within internal medicine that focused only on acute medical care, and that it should be done by one person or a team of people. And so the discipline known as Hospitalist Medicine was born.
Hospitalist Medicine became the most popular specialty for internists from 1993 to 2003. Many mid-career physicians discovered they liked the inpatient part because they have the time to spend with individual patients with less bureaucracy. Newly-minted internists now typically choose whether to specialize as a hospitalist or run a strictly outpatient practice.
When BMH decided to develop a Hospitalist Program, the concept held many unknowns. Fortunately, one of our consultants was Dr. Winthrop Whitcomb from Baystate Medical Center in Springfield, Massachusetts. Dr. Whitcomb was a colleague of Dr. Wachter and helped establish the Society for Hospital Medicine in 1993. He had seen different models for Hospitalist programs in hospitals of all sizes across the country. Through discussions with Dr. Whitcomb and our interdisciplinary committee, the true benefit for patients in having this type of care became obvious.
A patient with an acute medical need probably comes to the emergency room first for evaluation by our very capable staff. When the decision is made that the patient requires a hospital stay, a hospitalist is called in to write admission orders and, at the same time, communicate with the primary care physician if there is one.
There are patients who really want to see their primary doctor. On the other hand, they become very quickly converted to the fact that if they have a question, their hospitalist is right there. When BMH launched night hospitalist program, we noticed it has a positive, relaxing impact on patients. Knowing the doctor who was admitting them was going to be there was a great comfort and reassurance. Should there be an acute status-change, you don’t have to call up a doctor and wait. There is a rapid response team.
Hospitalists are also available to talk with the nurses and family members. Whether they have immediate questions or think of something two hours later, there’s a doctor here who can talk to them instead of trying to track down someone the next morning.
For primary care physicians who choose to participate in BMH’s Hospitalist program, their patient now has a team of doctors providing care. They may still come to the hospital to see the patient but they now have a schedule in their outpatient setting that’s reliable and predictable so they can see more patients.
The communication piece is really important. We do face-to-face reporting at the end of each shift and continue to work with Information Systems to develop better reporting tools. We recently built a web page that enables primary care physicians to monitor a patient’s progress through narrative reports. Our care managers call, fax, or email the primary doctor to notify them when a patient is discharged and give them the follow-up plan, including meds. The patient is also given information for their next visit to the primary care physician as well as a final report.
The Hospitalist program at BMH is voluntary, but most of our local physicians have embraced it and have come to appreciate its benefits. And from a patient standpoint, the quality of the care and accessibility to both outpatient and inpatient doctors has increased tremendously.
Follow this link to meet the physicians who work for BMH’s Hospitalist Service.