The headline was as biting as it was inciting. “Frustrations with hospitalist care: Need to improve transitions and communication,” it screamed from the cover of a recent issue of the Annals of Internal Medicine.1 Reading on the run, I thumbed to page 469 and glanced at the first few paragraphs, my mind spinning with the implications.
The article was an editorial following a recent thought piece by a primary-care physician (PCP) frustrated with his interactions with the HM model—mainly around the lack of communication from hospitalists about his patients, his marginalized role with his patients’ hospital care, and the lack of information transfer around transitions.2
Frustrations and Slapstick Comedy
Frustration with hospitalist care? Is this how PCPs see us? Are we really “frustrating” our outpatient colleagues? To an outsider, this presented a one-sided view of the issue—the side that sounds simplistically negative. What if someone important to our group should read this article, someone like my hospital CEO? I didn’t have to wonder for long as I looked up from my elevator reading to note my hospital CEO entering.
What followed eerily resembled one of those scenes from a slapstick comedy, as the boob, played perfectly by me, obviously fumbles something he intends to hide from his boss behind his back to escape the knowing eye of said boss. And, like a pornographic-magazine-sniffing parent, my CEO knowingly diagnosed the situation.
“Whatcha reading?” he sagely queried.
“Nothing,” I replied unconvincingly.
“Nothing? It sure looks like you hastily stuffed a magazine or something down the back of your pants as I walked in.”
“Oh, this?” I responded, unearthing a large medical journal from my pants, leaving an untucked shirt in its wake. “This is just a medical journal. You know, lots of medical stuff. It’s pretty complex. Probably hard for nonmedical types to understand,” I replied, employing a bit of professorial condescension to throw him off track.
“Annals of Internal Medicine,” he replied. “What a coincidence. I just received an e-mail from a friend with an Annals article about the issues of transitions of care with the hospitalist model. Sounds like a real problem. Maybe our new electronic health records will fix that. If not, you should fix it. Let’s chat about it soon.”
“Right,” I said as the elevator doors swished behind him, leaving me disheveled in both appearance and thoughts.
The more recent Annals editorial summarized—and then printed—a few of the many online responses to the original thought piece.3 The responses ranged from outrage with the HM model of care to more measured discussions of the limitations of the “old” model it replaced. However, the tone and implications were clear: At least some, if not many, PCPs are displeased with the HM model.
One writer related a recent example in which his elderly patient was admitted unbeknownst to him. After receiving a query from a family member, he called the hospitalist on duty, who was uninformed about the patient details, had made questionable therapeutic changes, and was “unapologetic” about her team’s lack of communication, arguing that the ED physician “should have called.” That led this PCP to conclude that the system is “disjointed and isolating,” leaving “patients feeling abandoned.” Another writer commented that the current system of communication results in “potentially detrimental and demoralizing degrees of separation.” A response by a hospitalist detailed how they were able to put a system in place to contact PCPs with whom they are contracted 80% of the time.