To do Inpatient Rounds or Not to do Inpatient Rounds?

I traveled back to Charlottesville, Va., for my 10-year medical school reunion. As I reminisced with my old classmates regarding the good times had in medical school, we all quickly began to quiz each other about our current practices. I was very surprised to see that many of my classmates that had chosen to enter primary care were outpatient only and a very small percentage of us were still making inpatient rounds.

I practice in a small town in southwestern Virginia and only a small percentage of the primary care physicians are outpatient only. Certainly the current shift in primary care is moving towards outpatient only, however for those of us still making inpatient rounds there is still quite a bit of satisfaction realized from the hard work. Certainly inpatient medicine is not for everyone. I will list a few of the reasons why I still choose to do inpatient rounds.

Continuity from the hospital to the office is not lost. I am able to recall the elderly lady's progress during her last hospitalization for an acute congestive heart failure episode. Medications that were added or deleted are readily available in my memory and the patient's chart is easily updated in my EMR as they are discharged. This can be very important so as not to duplicate or lose information when the patient comes back to the office for follow up. Not everyone remembers to bring their medication reconciliation list and if this information is not readily available, it can increase the time needed to complete the timely follow-up visit.

In my town, patients will migrate away from physicians that do not provide inpatient services. We are in a very small community and the current practice of letting the hospitalists do all of the inpatient care has not been well received by a large percentage of the patients in our community. I do frequently utilize the hospitalists for initial admissions and call through the week, however once the patient is admitted, I resume their care the day following their admission. This change has allowed me to have more time at home with my wife and young children but yet allows me to continue to provide the continuity of care during my patients' hospital care.

I still take weekend call and the current rotation is 1:4. Even though this rotation is more frequent than what I was used to in my last year of residency, it has not negatively impacted my family life. I take unassigned call during this time and still feel as if I am able to keep my acute care skills up to date. I suppose if our medical staff were to suffer severe attrition and the rotation increased to 1:3 or gasp, even 1:2, I might have to rethink my choices. However, it seems as every weekend call that I am faced with a very interesting panel of patients to care for and always finish the weekend with learning something valuable for my practice.

The constant tone from the pager through the week can be irritating to the daily office schedule, however none of my patients in the office ever makes a negative comment when I excuse myself from the exam room to answer a page. During one particular day last week when my daily inpatient census was a bit higher than usual, I was comforted to hear one of my patients tell me that they appreciate my hospital care and they do not mind when I have to leave the room. "Someday you might be taking care of me, Doctor, so you go on and answer that call and do not worry. Take your time and do a good job." That was very refreshing to hear, as I found myself rethinking my choice to provide inpatient care just before my patient made that comment on that particularly stressful day.

Who knows what my practice will find me doing in five or even ten years from now. At present, I plan to continue providing inpatient care because I feel as if my patients expect it from me. I still enjoy providing inpatient care, and as long as the joy of making hospital rounds is still there, I will continue to do so. Certainly making rounds is not for everyone, but for those of you still in the trenches wearing that pager, please rest assured that your patients appreciate your extra hours of hard work and dedication.
 

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