Recently someone on Twitter, supposedly a physician, replied to one of my tweets calling out misinformation and tried to catch me in some trap about vaccine-induced cardiac events. She went on to insult hospitalists as “assembly line” workers who don’t care about losing patients. She claimed our only goal is corporate-run rapid turnover and we are unaffected by patient loss.
The internet and its connectivity are a wonderful thing, but not always.
We as hospitalists know that what she said is not true. In fact, in the last two years alone, most of us have seen more loss despite our best efforts, and most of us have felt increased burnout, despair, and depression—the weight of that loss. We chose to be hospitalists to serve our patients in and around the hospital in this way as it fills a need. We may have high turnover, but while we sometimes feel embodied in that episode of Scrubs where doctors have to mentally move on quickly after losing a patient, we are a far cry from an assembly line. We love algorithms and checklists and risk scores, but after those, we apply our skills and our personal touch to our patient care. We are certainly not “unaffected.”
We as hospitalists also acknowledge that we work in a broken system, one whose capitalistic principles often undercut the quality of patient care we are able to provide. The system values profits over public health, and too many of the workers within are underpaid behind an illusion of “appreciation” from above, even as budgetary lines are drawn, and sacrifices are made. We know some of us must work within that system in order to change it because we are needed now, in modern medicine. Our primary care and specialist brethren are trying to meet time-consuming demands of their own which often prevent them from masterminding inpatient or perioperative care. That is where we shine! Not only that but for many of us it is where we thrive in a work environment. It is where many of us teach the rules of the system (and look at them with a critical eye) to the future of medicine and then WE can learn from THEM, partnering to change the rules to make that future better.
They already are working at it, by the way. The stereotype of the crusty old doctor complaining about “how it used to be” obviously still exists, but as I see trainees today unionizing for better working conditions to create a better learning environment to provide the aforementioned personalized care, I am reassured. This was highlighted during the recent Christmas blizzard in Buffalo, where the residents arguably prepared for the storm better than their attendings and PA/NP colleagues did. The overnight team came in midday on Friday and slept at the hospital to prepare for the night and relieve the day team. They supported each other and family members came to help other residents that got stuck in the snow. They communicated effectively and got each other through. The trainees are alright.
Eventually, that storm passed. By New Year’s Eve, the temperature was over 50 degrees, and you would never know there had been a snowstorm. Health care tends to do the same thing—it rises to an occasion, as we have seen with the pandemic, but is all too quick to forget the lessons that should be learned. When the storm (proverbial or literal) has passed, we must prepare for the next one, which is not how our system has evolved. Staffing well does not mean the bare minimum, stockpiling supplies is worth the cost, and medical research, especially in public health and preventative measures, deserves more funding and less red tape.
Further, the pandemic was a catapult to meeting medical issues in a modern way. Education has always been an important part of hospital medicine, now more so than ever as we help patients to take charge of their health care. To meet the future of hospital medicine, we have had to expand beyond the walls of the hospital. Misinformation has exploded in the past decade, especially in the past two years. Twitter (and its alternatives), Instagram, Facebook, and now newer sites like Substack, have become equal opportunities for anyone to post…well, anything. Political campaigns are literally run on rejecting evidence-based medicine and public health measures. Fellow physicians (including hospitalists) are embracing grift as they find alternative means of making money in a system that underpays them. We as hospitalists are joining fellow evidence-based physicians to fight back on these fronts and so many more.
At times my social media presence, modest as it is, feels hollow. But if I can reach even one person and convince them to abandon misinformation or embrace their health in a way shown to actually help, then I have done my job. It is difficult to maintain regular content (that is nuanced yet maintains the attention of those it must reach) amid the burned-out feeling that hampers productivity, or the overwhelmed feeling of looking at just how many topics we must try to address. This is where, while it may seem that we work as individuals, we must remember that we are part of a team – in this case a whole team of hospitalists and other providers who are reaching out to our little corners of the world and the Internet, and beyond.
As hazardous and treacherous as it may be to navigate, the future is one of connectivity, and the future of hospital medicine is connected. We are connected through social media, sociopolitical change, and community. Most importantly, hospitalists are connected to our patients, and that is how we remain an important part of medicine and a catalyst for its change.
Dr. Thomas is a hospitalist with Buffalo Medical Group and clinical instructor with the community-based Catholic Health Internal Medicine Residency in Buffalo, N.Y. He is passionate about patient education and reproductive justice, among other things, and writes a blog–Managing Health Expectations.
The Future of Hospital Medicine…is Connected is Dr. Joseph Thomas’ submission for the National Hospitalist Day HM Voices contest.