Tuesday, October 28, 2008

Advocate against "hospitalists"

I have said it once and I will say it a thousand times -- "hospitalists" are dangerous for the care, safety, health and lives of patients.

Hospitalists must be stopped.

If you or your loved one is a patient of a clinic physician who has hospital privileges and your loved one is hospitalized . . . demand (don't just politely request) that the clinic physician be the attending physician during the hospitalization.

"Hospitalists" are an absolute risk for the patient's health and safety.

My dad is a patient of Duke University Medical Center Clinic and Duke University Hospital.

Examples of "hospitalists" endangering the life of patients (and this is just in the small study group of my family):

1. I was a cancer patient in November 2006. I was admitted to Duke University Hospital for problems associated with chemotherapy.

A. Although my clinic oncologist referred me for hospital admission, the Hospitalist failed to contact my clinic oncologist.

B. The clinic nursing staff refused to schedule a post hospital follow-up appointment for me. "The Hospital does not tell us what to do."

2. My dad is a colon cancer patient. He underwent cancer surgery in April 2007, prostate reduction (non-cancerous) in July 2007. Dad was hospitalized in September 2007 with problems associated with chemotherapy.

A. Although the clinic oncologist referred dad for hospital admission, the Hospitalist failed to contact his clinic oncologist. Actually she refused to contact dad's oncologist and, despite a serious UTI, the Hospitalist refused to contact dad's clinic surgical oncologist.

B. The Hospitalist was pre-occupied with my dad's mental condition. Dad was scared, confused and disoriented. I explained to the Hospitalist that dad was fine until he became incontinent post chemotherapy. In addition, dad lost his balance a few days before the hospital admission and hit his head.

C. The Hospitalist ordered an MRI of the head when dad was admitted to Duke University Hospital. Dad was admitted with a subdural hematoma.

D. Dad fell in his hospital room at Duke University Hospital.

E. I requested a urological consult and asked that the Hospitalist contact dad's clinic surgical urologist (dad had just underwent prostate reduction two months prior at the same Duke University Hospital). The Hospitalist told me that she would contact his urologist. After 2 days, I contacted the Duke clinic urologist. The Duke clinic urologist had no idea that dad was in the hospital. The Duke clinic urologist came immediately to my dad's room.

F. After dad fell in his hospital room, I requested that dad be given a neurological consult. The staff at Duke University Hospital told me "[w]e only have one neurologist and that doctor is busy with important cases. Your dad's case is not important."

3. My dad was re-hospitalized (by his Duke clinic oncologist) at Duke University Hospital in November 2007 with a violent, oozing skin rash. The Duke clinic oncologist expected that dad would have 3 days of IV antibiotics.

A. The Duke University Hospital Hospitalist told me that his skin was fine and he did not need any antibiotics.

B. The Duke University Hospital Hospitalist discharged my dad on a Thursday with some oral antibiotics and no instructions for caring for the skin rash.

C. On the day after hospital discharge (a Friday), we returned to the Duke clinic oncologist because the skin rash was extremely painful and badly draining.

D. Four days after hospital discharge (a Monday), dad had difficulty breathing and was hospitalized again with a bad case of pneumonia.

My dad was re-hospitalized (by his Duke clinic oncologist) at Duke University Hospital in August 2008 because he was weak and could not move.

A. The Hospitalist demanded that my father speak, despite the massive swelling and infection in his mouth. Dad also had an infection and deep wound on his elbow and foot.

B. The Hospitalist told me that she would not confer with dad's Duke clinic physicians.

C. I explained to the Hospitalist that dad was perfectly cognizant unless he was in a hospital. Hospitals scare my dad and he gets confused easlily when he is scared. The Duke University Hospital Hospitalist had labeled my dad demented and he was being treated poorly. (I hope that is not the typical treatment of a demented patient.)

D. I told the Hospitalist that I did not want her treating my dad. I walked to the Duke clinic and begged for the help of the Duke clinic oncologist. The NP came to dad"s hospital room and arranged the cooperation of the "hospital team."

E. Dad received no orthopedic consult (
In February 2008, dad underwent orthopedic surgery to fuse the bone where the foot infection was located.)

F. Dad received no infectious disease consult.

G. Dad was discharged after over 2 weeks in the hospital. Dad still had the infection in his arm and foot.

H. Dad was returned to his home via ambulance because he could not even sit up!

5. It is October 2008 and dad is back in Duke University Hospital.

A. The infection in dad's foot never healed. I contacted dad's clinic orthopedic surgeon because dad could not walk without pain.

B. Dad's Duke clinic orthopedic surgeon immediately knew that dad needed surgery to remove the infection.

C. Dad had surgery had Duke University Hospital yesterday. The infection (that was present during the August 2008 hospitalization) had gone deep into the bone and destroyed the February 2008 ankle fusion.

D. Dad returns to the operating room in 2 days to complete the removal of the infection.

Something needs to be done about the communication between Hospitals and Clinics. Hospitalists may save a lot of money. But they simply do not know the patient well enough to assume care from the clinic physician.

This is a very scary process with Hospitalists assuming care from clinic physicians.

I shutter to think what will happen if Barack Obama gets his way and makes our medical care system socialist.

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