Hospitalist: Lousy name, great idea

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The New York Times has a fascinating piece on a fast growing medical specialty: hospitalists. They are a modern day hybrid, part administrator and part caregiver.

They spend quality time with patients that family doctors, making hasty morning rounds, barely visit. They coordinate medications, double-check diagnoses, make sure that patients and their families fully understand what they must do upon discharge so that the patient doesn’t end up readmitted a week later.

But perhaps even more important in the long run, they are also trained computer geeks, adept at designing systems that contain costs, coordinate treatment, and manage workflow so that a minimum of staff can provide a maximum of care.

The name hospitalist, at least to me, conjures up a stodgy bureaucrat, someone who pushes pencils, loves saying no, and finds ways to benefit the hospital at the patient’s expense. But forget the name, these folks are the mirror image of that. They are proactive. They do not seek ways to cover the hospital’s tush if the readmission rate is too high; they seek systems to bring it down.

In 65 participating hospitals around the country, the Society of Hospital Medicine identifies patients at high risk for readmission, provides staff mentoring, and designs user-friendly discharge forms listing follow-up appointments, potential signs of trouble and phone numbers for the hospital team. Peer-reviewed research on the reforms in the system is expected in a year or two.

Even experts who were initially skeptical agree that the hospitalists’ skill set is timely. They are young and thus not entrenched in the current order. They enjoy working in teams, when older doctors tend to be hierarchical.
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At meetings with her fellow hospitalists, phrases seldom spoken by most doctors, like “cost-effective delivery of care,” and “preventable adverse events,” flow off everyone’s tongue: The language of health care reform.

That last sentence is probably the most important. The health care reform bill will be a bear to enforce. But think how much easier it will be with a new cadre of doctors on hand, who have no good old days to mourn, no vested interest in prescribing unnecessary tests, equal allegiance to patient and hospital. but none to insurance companies.

It is a true reason for hope.