Working With Your Hospitalist

I tell my patients that my job as their primary-care physician is to keep them out of the hospital if at all possible, but also to recognize when they need round-the-clock, inpatient medical care. When that time comes, I am happy to sign them over to the expertise of a hospitalist. Currently an estimated 28,000 physicians work as hospitalists, providing inpatient care to patients so that primary-care physicians can focus on outpatient medicine.

After two years working as a hospitalist, I am now a clinic-based family doctor. Having worked both sides of the aisle, I’ve learned some useful strategies for making hospitalizations smoother for both physicians and their patients. Here are some simple tips that will maximize your patients’ experience:

• Inform your patients that you use hospitalists. While hospitalists have been around for more than ten years, patients are often surprised that their PCP does not take care of them in the hospital. Discussing this long before your patient needs admission may reduce his frustration when he is sick.

• Verbal reports help your patients. If there is a social issue or piece of the patient’s medical history that will assist the hospitalist, a simple call may shave days off the hospital stay. Remember, you know your patient best.

• Save outpatient workups for later. Your hospitalist may agree to run tests you request while the patient is hospitalized, but insurers are unlikely to pay unless it is directly related to the admitting diagnosis. Unnecessary tests may add days to the hospital stay as well. If the test or evaluation can be run as an outpatient and has nothing to contribute to the current treatment, plan to do it after discharge.

• Avoid placing orders. If you have hospital privileges, you may be tempted to try to control your patient’s pain or other symptoms while she is in the hospital while deferring the majority of the care to the hospitalist. This fragments the patient’s care and confuses the nursing staff. Instead, call the hospitalist and offer your suggestions.

• Expect a timely discharge summary. When the patient returns to your care a few days after discharge, you need to know his new medications, results of his tests, and plans for further workup. If your hospitalist has not dictated the report, you may call him or her and ask for a verbal summary.

• Provide feedback. If many of your patients comment that a hospitalist was rude or inattentive, you may wish to discuss it with the physician or with his or her supervisor. On the other hand, if your patients rave about a specific physician, share that, too.

The relationship between the clinic-based primary-care provider and the hospitalist need not be adversarial. After all, both providers want a short hospital stay, effective communication, a safe discharge plan, and a good outcome for the patient.

Sarah Parrott, DO, is an assistant professor of family medicine at Kansas City University of Medicine and Biosciences in Kansas City, Mo. She may be reached via physicianspractice@cmpmedica.com.