When we got the letter from the hospital - offering the new hospitalist service to us .. we told 'em we would give it a try. So for the past few weeks, if an adult patient of ours comes to the ED, we are supposed to get a call from the ED physician. S/he will describe the situation, and we will have a choice of whether to admit the patient ourselves, or allow the hospitalist to care for the patient. They assured us that there would be excellent care and good communication. So we said we would give it a try.
It makes sense. We usually have only one or two patients in the hospital. Just driving there and back takes more time than seeing the patients, so it's a lot of time .. and one could argue that the patients may get better care and/or service from someone who is always in the hospital.
Two nights ago, the husband of a patient called because his wife was in the hospital. She was admitted "with a kidney infection" and now urology said that it wasn't .. and neurosurgery said it wasn't a herniated disc .. but no one had been "in charge" of the visit (from the family's perspective) .. and they were frustrated and angry.
"uhhhh" says me. I didn't even know she was in the hospital. They never called me. Just admitted her to the hospitalist service.
So ... like any geek-physician, I logged on to the hospital's computer system and saw that her WBC on admission was 6.5 .. and there were scant RBC (no wbc) on a cath urine specimen from admission. Renal ultrasound was negative, and an MRI of the l/s spine showed mild herniation at L4/5 .. with no nerve root impingement.
Then I visited her in the hospital yesterday morning. The admission H & P was dictated and very thorough. From there, the four day admission read like a team of blind men were treating an elephant. A different hospitalist saw her every day and ordered new tests and new specialist consultations. She was confused and angry and the bottom line is that this poor woman had back pain. Frustrating and painful .. but something that probably should have been managed outside of the hospital from the beginning.
I nudged the very nice physician's assistant who was seeing her yesterday (for the first time) for the hospitalist service to discharge her asap .. and I would see her in the office in a few days. I sat with her for five minutes and listened ... something no one had done in four days .. and she felt much better ... eager to go home.
Maybe this hospitalist thing isn't gonna work ...