Type a medical condition or term into a search engine and watch what happens. A search on the words “diabetes” yields more than 13 million Web pages, and “pneumonia” produces another 1.65 million. In 1998, the Internet hosted approximately 5000 health-related Web sites; two years later that number quadrupled (1). Between 30,000 and 45,000 medical articles on various drug therapies are published annually. The Patent and Trademark Office issued between 2000 and 4200 drug patents each year between 1979 and 1989 (2). The National Library of Medicine reports that it adds more than 2000 journal article citations to its MEDLINE database on a daily basis. In 2003, more than 460,000 citations were entered.
Deciphering and applying this myriad of changing information is a critical activity in the medical field. Without disseminating new knowledge through ongoing education, medical practices and procedures would become outdated, and uninformed medical professionals and patients would continue to operate under misinformation that might be detrimental to health or worse.
Hospitalists as Inpatient Experts
In an inpatient setting, hospitalists are uniquely qualified to play the role of educator. They analyze and interpret a wide range of medical information to treat their patients and provide updated information to patients and their families, residents, interns, nursing staff, other health care professionals, and hospital administrators. The hospitalist can be viewed as the “hub” of educational activities in the inpatient environment, absorbing, synthesizing, and disseminating information. They are “inpatient experts” in the following five spheres of knowledge:
- patient management
- clinical knowledge
- clinical skills
- health care industry issues
- research and management/leadership (3)
Hospitalists are uniquely qualified in the sphere of patient management, efficiently and effectively guiding the patient through the mazelike inpatient environment. Most hospitalists are quite familiar with critical hospital functions and activities, including treatment in the emergency department, the admissions process, bedside care on the medical floor, treatment in the intensive care unit, and the discharge process. Hospitalists, because they understand “how to get things done” by ancillary departments, including diagnostic and therapeutic services, often find themselves as conductors of inpatient care. Many hospitalists have developed unique proficiency in co-managing surgical cases due to expertise in peri-operative evaluation and care. Hospitalists are recognized as inpatient team leaders, facilitating and coordinating a range of support services needed to treat the patient, including nursing, case management, pharmacy, occupational/physical therapy, and social work. Hospitalists must also be effective in managing relationships with health care personnel external to the inpatient environment, including community physicians, homecare providers, extended care facilities, and visiting nurse services. Finally, hospitalists are oaen well informed about hospital processes, procedures, rules, regulations, and information systems.
As inpatient generalists, hospitalists continually treat the most common reasons for admission and have exceptional clinical knowledge of these conditions. These conditions include pneumonia, deep vein thrombosis (DVT), congestive heart failure (CHF), diabetes, end-of-life care, and other medical diagnoses. Since they treat many elderly patients, hospitalists are considered experts in managing patients with multiple co-morbidities. A related area of expertise is clinical guidelines/pathways, quality of care metrics, and practice standards. Since they spend nearly all of their time treating inpatients, hospitalists develop extraordinary familiarity with the clinical rules and tools supporting the patient care process.
In addition to clinical knowledge, hospitalists have the experience and expertise to teach inpatient clinical skills. These skills include diagnosis, physical examination, discharge planning, medical chart recording, family meeting coordination, and oversight. Also, most hospitalists are familiar with a range of technical procedures, including insertion of central lines and arterial lines, lumbar puncture, arthrocentesis, paracentesis, and thoracentesis.