When Robin Orr was admitted to the ED of Santa Barbara Cottage Hospital (Calif.), she brought a long history of experience with hospitals, both as a patient and in her professional life. Orr is a cancer survivor who had undergone back surgery several months earlier and had suffered from increasing back pain since the surgery. Late one Friday night in June 24, 2005, the pain was so intense that Orr’s care partner, Sue Cook, brought her to the ED. Orr was given morphine and taken to a room for the remainder of the night.
Who Is Robin Orr?
Orr was no ordinary hospital patient. With nearly three decades of experience as a healthcare professional working with hospitals, she was well aware of how hospitals should work—and how they often don’t work. After seven years as a hospital administrator, she went to graduate school for a master’s degree in public health, then spent 12 years as executive director for Planetree Health Resource Center, San Francisco, a nonprofit consumer healthcare organization that focuses on patient-centered care. While Orr was with Planetree the organization created a revolutionary demonstration project that brought patient-centered care to three model sites. The project centered on changing the hospitals’ physical environments as well as providing patients access to their own medical records.
Approximately 12 years ago, Orr left Planetree to start her own consulting practice. The Robin Orr Group (Santa Barbara, Calif.) works with healthcare organizations to effect patient-centered care. At the time she was admitted to the ED at Cottage Hospital, Orr’s consulting work was tapering off as she struggled with constant pain.
Enter the Hospitalist
At 7 a.m. on the Saturday the morning after Orr was admitted, Eric Trautwein, MD, checked on her. Dr. Trautwein is a hospitalist with the Samsun Santa Barbara Medical Foundation, which employs approximately 200 physicians in multiple specialties.
“Eric was a breathe of fresh air,” says Cook. “He … had read all her charts and immediately asked about the pain and got it under control.” Throughout the ordeal, Cook says “everyone would ask Robin what the pain level was, and she’d say ‘11,’ and they’d write it down. Eric did something about it.”
The next step, as Cook recalls, was a thorough examination. “I’ll never forget—he noticed that one knee reflex had a very subtle difference,” she says. “He wanted to double check that, saying he never made assumptions. He immediately got tests scheduled for that day, which was a Saturday. That never happens.”
Orr was scheduled for an immediate CAT scan, PET scan, and MRI. The results were available by Monday: The tests showed a mass of 4.5 x 3 cm to the left retroperitoneum adjacent to the aorta, consistent with metastatic disease.
After months of dealing with healthcare professionals who focused on and treated Orr’s pain, both Orr and Cook believe that the hospitalist’s diligence in performing a thorough exam and insistence on immediate tests were remarkable.
“A hospitalist saved my life,” Orr says confidently.
Dr. Trautwein doesn’t feel his exam and diagnosis were unusual.
“I’m not sure I did anything special,” he says. “I know for sure that my partners would have done the same things I did, and so would most hospitalists.”
After the Test Results
At the end of the weekend during Orr’s stay, Dr. Trautwein’s shift ended and his partner, Jeffrey Yim, MD, took over. Before the change, Dr. Trautwein assured the women that he’d go over Orr’s case with his partner, and that he would stay in touch. This is standard procedure among the hospitalists in their practice.
“We’ll ask if there’s anything they want us to convey to the new doctor” before we go off shift, says Dr. Yim.
The hospitalists at Samsun Santa Barbara Medical Foundation take great care with transitions during shift changes because they are aware that mistakes can happen if communication is incomplete.
“Hand-offs are one of our biggest challenges,” says Dr. Yim. “Ours aren’t formalized, but we follow a standard practice of leaving what we call an ‘off-service note.’ This is very comprehensive, almost like a discharge note, and includes all important details. In addition, the outgoing and incoming hospitalists have a sign-off conversation, either in person or over the phone, to cover any social issues or dynamics. With Robin, for example, pain control was an issue.”
Dr. Yim told Orr and Cook the results of the tests.
“Dr. Yim came in on Tuesday, and it was like passing a baton in an Olympic race,” recalls Cook, who is an expert and author on customer service. “Both [of the hospitalists] have empathy, [a skill that is] relevant and timely, and a sense of urgency.”
Orr agrees that Dr. Yim’s care was as helpful as Dr. Trautwein’s.
“Both hospitalists made sure I was treated as a human being; they weren’t just treating my pain,” she says. “Dr. Yim made sure I got what I needed at discharge, which was very necessary. He was on top of it and made sure it included follow-up.”
In Praise of Hospitalists
Despite her profession, Orr says she had never heard of hospitalists before meeting Dr. Trautwein. In addition to her gratitude to him for diagnosing her cancer, she was very impressed with how the role of hospitalist affected her care.
“I felt that having a hospitalist helped streamline the process,” she says. “I was admitted through the ED in the middle of a weekend night, when labs were closed and I had no access to my primary care physician. Despite the timing, there was continuity and follow-through, and there was speed of action.”
Orr was particularly impressed at how the various departments of the hospital worked together, with a hospitalist acting as her champion with all of them.
“[Eric] has a familiarity with hospital resources and knew who to call and when to call,” she says. “He passed the baton between people in such a way that I felt I would not be dropped between departments. There were great communications, and it helped with the ease of streamlining and continuity, and it certainly helped my peace of mind.
“From the perspective of a health professional, I could see that a hospitalist helps eliminate waste,” Orr continues. “I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.”
Orr had a first-hand view of how hospitalists streamline processes and influence care for individual patients. Her experience as a patient was an educational time for her, even with her substantial background working with hospitals.
The Hospitalist’s View
While Dr. Trautwein is pleased with the outcome of his assessment of Orr, he insists that he was doing his job. In fact, he believes the toughest part of being a hospitalist is not detecting hidden illnesses, but building trust.
“The biggest part of my day is communicating. I feel like I don’t have much time to establish trust with patients,” he admits. “That’s by far the hardest thing about the job. You only get one pass to go over their medical history, but you also have to build a rapport with them. It’s not easy.”
With each new patient he sees, Dr. Trautwein is aware that that person is wary of seeing a new doctor rather than their own primary care physician.
“A lot of people are skeptical when they see a new [doctor]—especially a young doctor,” he explains. “Sometimes, I’ll start by trying to talk about something unconnected with their condition, to try to connect with them as a person. Getting patients to trust you is one of the more difficult parts of the job, but it can lead to one of the greatest satisfactions.”
As a hospitalist, Dr. Trautwein has a clear view of his role versus that of a primary care physician, and sees the value in being available to hospitalized patients.
“Primary care physicians are squeezed from every direction and can’t be around their patients in the hospital all the time,” he says. “Hospitalists get the patients’ attention; it’s not hard to drop back into someone’s room. For the patient, that’s important. They see that we care about them, and we can make the face-to-face contact with them that used to be impossible.”
Dr. Trautwein makes a special effort to see each patient as often as he can, and to share information with them.
“I try to think about it from the patient’s perspective,” he says. “The major thing that patients are hungry for in a hospital is communication.”
As for his ability to get tests scheduled on a weekend, he says that Cottage Hospital “is a pretty responsive hospital in general. I don’t spend a lot of time banging my head against the wall with them. If I talk to a person directly, in person or on the phone, they’ll respond. It is unusual to have tests done on the weekend, but it was also unusual to have a patient who needs them so much.”
Dr. Trautwein understands that a normal day’s work for a physician can mean a life-changing diagnosis for a patient. Orr and Cook understand it, too, but from their perspective, a hospitalist doing his job can lead to a miracle.
At the time this article was written, Orr had completed a round of radiation and was recuperating as she awaits further test results. Despite her ordeal and her pain, her outlook is as positive as her praise of hospitalists. Looking back on her experience at Cottage Hospital Santa Barbara and Dr. Trautwein’s role, she says, “The outcome of all this was my peace of mind as a patient. You can’t buy that in a hospital anywhere in America today.” TH
Contributor Jane Jerrard writes the “Hospital of the Future” series for The Hospitalist.