Nice to Meet You

Susan Connelly of Fruitland Park, Fla., is a volunteer at her local community hospital who until recently had never heard of a hospitalist. One day, she entered a hospital room and, as she regularly did with patients she visited, asked if there was anything the man in the bed needed.

“I want to know where my doctor is,” the patient said.

“You mean your doctor hasn’t seen you?” Connelly asked.

“No,” he said. “I’m not even sure he knows I’m here.”

Somewhat incredulous, Connelly retrieved the hospital’s physician handbook and helped the patient look up his physician’s phone number. “I didn’t think too much about it,” she says. But the following week, when she appeared at the hospital to volunteer, a supervisor called her into the office. The supervisor asked Connelly about the incident and gently admonished her for encouraging the patient to call his primary-care physician (PCP), as “a hospitalist is working with him now.”

“A what? I had never even heard the term,” Connelly says. She asked her fellow volunteers, known as patient representatives at her hospital, if they had ever heard of a hospitalist. One had, but only because her husband had been admitted for a hospital stay. Concerned, Connelly wrote letters to the editors of two local newspapers. Both were published (see Figure 2, “Familiar Face Gone Missing,” p. 30).

We need to stress in residency training the specific issue of helping make the patient feel comfortable when their own doctor is not seeing them in the hospital.

—Robert Centor, MD, associate dean of medicine, University of Alabama at Birmingham

“If I am admitted to the hospital, my doctor will most likely ‘dump’ me on what is now called a ‘hospitalist,’ ” she wrote. “Information gathered [by the hospitalist] should be forwarded to your doctor; the key word is ‘should.’ Why develop this long-term relationship with a doctor, if when you really need him, he is not there for you and you are dealing with a stranger?”

Why indeed?

It might not happen with every new admission, but patient fears are a reality. The uncertainty of a hospital stay, a new physician, and new medications can take their toll on the human psyche. Patients are upset with their PCP, the hospital, the system; many times it’s the hospitalist who feels the brunt of their anger. Not only do hospitalists have to calm a patient worried about PCP disconnect, but they also have to reassure the patient that they will be attentive to their needs, provide a high quality of care during the hospital stay, and communicate with their PCP about diagnoses, medications, and follow-up care. Hospitalists should weave in some of the documented plusses a hospitalist brings to the table: shorter length of stays, greater patient access and availability, and improved quality of care.

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