The workday of a hospitalist at Hamad General is strikingly similar to the one he knew as an academic hospitalist in Boston.
“Models we are introducing include extended hours coverage, evenings and weekends, proactive discharge planning, and co-management with specialists,” he says. The health system is also rolling out an electronic health record.
Still, his adaptation to a new medical system has generated many curiosities in the sports-mad, fully wired-for-Internet nation, which has the world’s highest per capita standard of living.
“Every now and then, I look around and think: ‘This isn’t Kansas anymore, Toto,’” Dr. Kartha says, adding that he has learned about important cultural and religious beliefs and traditions that affect patients’ attitudes toward health and healing.
Arpana Vidyarthi, MD, associate professor in the Duke-NUS Graduate Medical School in Singapore, previously worked as a hospitalist at the University of California-San Francisco (UCSF) before moving to Singapore in 2011. She thinks “pockets” of hospital medicine are being practiced all over the world “in response to local needs.”
“The model is manifest in a diverse fashion throughout the United States, yet it is agile enough to be adapted around the world and be truly relevant,” Dr. Vidyarthi says. “But local tradition and the way hospitals are structured will determine how the model is established.”
Traditionally, medical specialists, often without a central physician to coordinate care, manage inpatients in Singapore, according to Dr. Vidyarthi. At discharge, they are referred to numerous subspecialists and to a public health clinic. Half of hospital wards are staffed by “super-specialists,” the other half by general internists who see patients both in the clinic and in the hospital, she says.
“This is not hospital medicine as we know it in the United States,” she says, “but different models are evolving.”
Listen to Dr. Henry Feldman discuss his work helping physicians overseas advance their medical informatics programs, patient care, and dissemination of “Open Notes”.
Ten years ago, physicians from Singapore visited UCSF to observe how hospital medicine was practiced there. A family medicine hospitalist program was piloted in 2006 at Singapore General Hospital. The program helped reduce lengths of stay and costs of care without adversely affecting mortality or readmissions.1
Kheng-Hock Lee, MD, one of the researchers and president of the Singapore College of Family Physicians, says that defining a generalist role for hospital medicine in Singapore has been difficult.
“When I call myself a hospitalist here, there is a strong reaction from some who perceive it as profit driven,” Dr. Vidyarthi says. “Clearly, there is a need for a generalist physician at the center of the patient experience, to manage the complexity of the patient as a whole person, as well as the hospital system. That is where it’s emerging within internal medicine, whether it’s called hospital medicine or not.”
For the past year, Dr. Vidyarthi has been working at Singapore General.
“The concept of the academic hospitalist is new here. People are able to see when I’m on service that I do things differently. This is because of the hospitalist mindset I brought from the United States,” she says. “Because I have a systems lens, I organize my day differently than the other doctors. I teach concurrently with clinical care, delegate responsibilities and accountabilities, and focus on discharge from the first day of admission.
“In general, my team is happier and my patients have lower lengths of stay.”
Defining a Specialized Expertise
Whatever you call it, there is a need around the world for physicians to practice in hospitals—to help standardize care, improve quality and patient safety, and prevent waste. Peter Jamieson, MD, a family physician in Calgary, Alberta, Canada, and medical director of the Foothills Medical Centre, has worked as a hospitalist since 1997. He didn’t call himself a hospitalist at first, “but the concept is becoming better socialized and more widely recognized in Canada.”