LEGACIES

‘You are what kind of doctor?’

Remembering hospital medicine’s early years


 

Editor’s note: The Hospitalist is pleased to introduce a new recurring column: “The Legacies of Hospital Medicine.” This will be a recurring feature submitted by some of the best and brightest hospitalists in the field who have helped shape our specialty into what it is today. It will be a series of articles that will reflect on hospital medicine and it’s evolution over time from a variety of unique and innovative perspectives. We hope you enjoy this series, and we welcome any feedback as it evolves!

Hearkening back to my early time as a hospital-based physician, I recall the pleasure of waking every day and feeling like I belonged to an exclusive club. I felt passion for my work, along with a tiny cohort of similarly situated docs. We lacked a kinship with other medical organizations, however. We had no union of our own and were invisible upstarts.

Bradley Flansbaum DO, MPH, MHM, a hospitalist at Geisinger Health System and member of the SHM Public Policy Committee

Dr. Bradley Flansbaum

While some folks might have perceived our splintering from the mainstream as a liability, back then, we wore it like a badge of honor. No home office. No funds. No central hub to tap into when a notice needed dispatching. We were setting the world ablaze. Or so it was our delusion.

And the question always came: “Tell me again ... you are what kind of doctor?”

The response changed every week. Ditto for my job responsibilities and charges. The memories are wonderful, though, and I have great affection for the early years.

Initially, I recall networking and attending national meetings – SGIM and ACP in particular – spreading the faith and talking up our bona fides. In addition to the registration fees, there came an earful of guff from irate physicians about the new breed of doctors, yet unnamed, who were destroying medicine. Likewise, I recall opinion columns from newspapers and peer-reviewed journals from a spate of “simple country docs.” The writing had a pretense of politeness but with a hint of disdain, predicting nothing less than the destruction of health care as we knew it. And to be standing next to them in conversation: “How dare you hospital docs exhale CO2!” We might as well have had “KICK ME” signs on our backs.

Inpatient medicine was upending the status quo – or so we believed – while also overturning a generations’ worth of dogma on how hospitals should do their business. Fate also played a role, and we could not have anticipated the arrival of health care consolidation, “To Err Is Human,” managed care, and payment reform – all of which upset practice conditions that had been in existence for decades. We walked a line between old and new, down a path whose purpose we felt but toward a destination we could not entirely envision.

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