Wednesday, December 31, 2008

Hospitalists do not like me

Recently a blog that I truly respect (The Happy Hospitalist) mentioned my being the “Anti-Hospitalist.” I took it in good spirit and explained my points while also remaining respectful and asking where I am going wrong.

I never personally insulted any of these hospitalists. I was trying to exchange information. I would think that professionals (especially doctors) would want to know where the weaknesses are in the system. Apparently no.

I highlighted the most offenses personal attacks at me.

What follows is the initial post and comments to the post. And, this type of attitude is consistent with the attitude of hospitalists that I interact with.

You readers decide what you think of hospitalists!

INITIAL POST: Rough commentary on the hospitalist medicine model. It sounds like some really bad experiences have driven her point of view. Most of her concerns, I think, are site specific, and not indicative of national trends.

Where's the love?


12 Outbursts:

1. Anonymous said...

And she's an attorney. Ouch!
December 30, 2008 8:13 AM

2. tracy said...

Spooky!
December 30, 2008 11:32 AM

3. jodigirl1000 said...

Aww c'mon, she sounds really cool. And she is starting a masters program at Univ of Illinois on patient safety and error science.

Just imagine how thrilled the docs are when they find out her dad is on their floor!

Tell her where she is going wrong -- she wants to learn and help the system --- not just preach.

Happy & healthy New Year to you all

Love, an anti-hospitalist
December 30, 2008 5:50 PM

4. Anonymous said...

Little of what she complains about is prevalent in hospitals I've been associated with. I'm an IPC employed hospitalist, and our company absolutely stresses communication with PCP's, consultants, families, etc. as one of our top priorities. It appears that she has an ax to grind with her father's specific situation and rather than treat it as an incident, she generalizes and assumes that all hospitalist programs and physicians are just like that.

And her questions listed about accountability and liability indicate that she lacks even a basic understanding of how things operate. Can't take her too seriously after that. It's like somebody criticizing how a car drives and then asks how to turn it on. Get a clue, lady.
December 30, 2008 6:32 PM

5. Anonymous said...

She has turned a bad experience with Duke hospitalists into a vendatta against hospitalist's in general. After reviewing her site she clearly lacks understanding as what set off the hospitalist movement. She lacks understanding that the majority of PCP's can no longer see inpatients, see outpatients, and finacially or mentally survive. She lacks understanding that foreign MD's can be every bit as good and better than US MD's. She also has taken a very cowardly approach to her issues with the Duke hospitalists. Instead of filing a complaint with Duke or the state medical board, she names doc names on here website giving a one-sided story which may or may not have happened as stated. That is not how professionals act.

File a complaint with the medical board and quit being a coward.
December 30, 2008 6:33 PM

6. Anonymous said...

O.k. I hear what you are saying, but please address these two items that I saw perusing her site:

1. Ruling out a UTI by dipstick only, (I know dementia or heightened dementia w/ aggression/aggrevation can be the only sign of a UTI in elderly women too although my grandmother was already demented - they would dope her up on haldol only to find she had a UTI they could not get cleared) and

2. "The traditional teaching hospitals are a dying breed. I have seen young residents at Duke University Hospital make recommendations....just to have a hospitalist override the young resident without explanation. Those over-riding confuses the patient and robs the resident of the opportunity to treat patients with the supervision and oversight of the medical school.

Certainly the hospitalists are not the supervising physicians/ professor for the resident or fellow. In fact, the hospitalist competes with the resident for "turf."

Is this true in teaching hospitals these days?
December 30, 2008 8:11 PM

7. jodigirl1000 said...

Hey I am hardly a coward. I am right here asking why I am wrong.

I absolutely understand why the hospitalist model started. $$. I am sorry that some PCPs do not want to follow patients that they admit to the hospital. That seems a shame. And it seems like the hospitalist model costs more money when patients are re-admitted within a few days or weeks because the hospitalist missed a dx (because that hospitalist refused to cooperate with a non-hospitalist admitting or attending).

When a doctor admits a patient or is the attending physician, the hospitalists should respect that. And the hospitalist should defer to the admitting or attending's judgment.

Hospitalists (in at least 3 hospitals in different states) have told me that they will not communicate, coordinate or cooperate with the non-hospitalist attending or admitting.

The hospitalists lack an important clinical element --- the medical hx of the patient.

Refusing to work with non-hospitalist admitting or attendings frankly jeopardizes patient safety and health.

Aww, I have no vendetta. My experiences with Duke are actually based on my dad's 10+ experiences, my personal hospitalizations (at Duke and in Illinois) and from talking with many other patients and Duke physicians and surgeons and para professional staff. The Duke docs and nurses are frustrated. They are told to hand-off to hospitalists and then (as Northwestern Univ physicians have told me) the typically turf war begins.

There has been no study on the issue of patient safety and continuity of care as it relates to hospitalists. That concerns me.

I am working with Duke Risk Management to try to find a system whereby communication and coordination is assured. Hardly a vendetta. I just expect accountability. I think the system could work better and I am working on ways to make that happen.

My "vendetta" (and I do not even characterize it as that) is the lack of doctor discipline in Illinois. Patients are simply not protected. "Bad doctors" are IMHO a major cause of increased medical costs.

My questions:

(1) Why do we need hospitalists in traditional teaching hospitals (please dont tell me that the teaching hospital model is dying . . . teaching hospitals and research are why the US medical system is so fantastic!)

(2) What motivates a med student to want to be a hospitalists? Are they frustrated administrators? Do they lack the inter-personal skills to ever have a successful clinic practice? That is why I wondered whether it is a specialty geared to foreign medical grads.

No need to file suits. I am interested in fixing a problem. I communicate regularly with the Joint Commission and accrediting commissions. Again, hardly a coward.

Thanks for the input for me. We are all on the same team improve patient safety and create a system where patients have positive medical outcomes.

I admire and respect all of you. See, there is love.
December 30, 2008 11:21 PM

8. Anonymous said...

Anon 6:33 here:
Sorry Jodie but when I read your response, I come to the realization that you know very little about medicine and how it is practiced.

1: re: ""I absolutely understand why the hospitalist model started. $$. I am sorry that some PCPs do not want to follow patients that they admit to the hospital."

It is NOT just about money. Let me give you the life of a general internist pre-hospitalist
05:00-07:30: round on inpatient's
08:00-17:00: clinic
17:00-19:00: post clinic phone calls, dictation, etc, etc
19:00-21:00 (or later): round on inpatients.

Day in, day out. This leaves out call. Tell me is that quality of life to you? that is prescription for divorce, burn-out, and mental breakdown. throw in now that third payers have put the screws to clinic docs such that EVERY inpatient is a money loser when travel time is taken into account. It doesn't take a genius to figure out the rise of the hospitalist.

2: "When a doctor admits a patient or is the attending physician, the hospitalists should respect that. And the hospitalist should defer to the admitting or attending's judgment"

A hospitalist IS an attending physician. As far as "deferring" to the "admitting" or "attendings" judgment that really depends on the issue. If the issue is urologic....agreed. If it is medical...I don't necessarily agree. IMO if there is a difference of opinion, then that deserves a phone call.

3: re: "Hospitalists (in at least 3 hospitals in different states) have told me that they will not communicate, coordinate or cooperate with the non-hospitalist attending or admitting."

In my hospitalist days (I am now a subspecialist) I called the primary doctor at discharge of EVERY patient to give an update and send a dictation to all the docs involved including the PCP (we all did per our practice model). What you are telling me "happens" is nothing more than bad patient care and a law suit waiting to happen. Really now, most docs aren't that stupid. Now if you are saying that a consulting hospitalist should be an admitting subspecialist's scut-boy. that is a different issue. IMO to consult a hospitalist so they can play case manager is medicare fraud pure and simple(consulting a doc for a non MD needed reason).

4: re: "The hospitalists lack an important clinical element --- the medical hx of the patient.

Refusing to work with non-hospitalist admitting or attendings frankly jeopardizes patient safety and health"

Both are true statements HOWEVER, I (and every hospitalist I have ever worked with) have called PCP's/specialists with questions if needed. It really just makes sense. In all honesty, with people who have had multiple admits much of the record is already on file. Of course it should be reviewed with the patient/family for accuracy. When there are questions, I call the doc in question. That is what most docs do. Again, this is common sense.


5: re: " (1) Why do we need hospitalists in traditional teaching hospitals (please dont tell me that the teaching hospital model is dying . . . teaching hospitals and research are why the US medical system is so fantastic"

Very simply because of the 2003, 80 hour work rule (look it up). Resident's don't grow on trees (even at Duke). When the resident has capped or has passed the 80 hour rule what do you think happens to the overflow patients? Do you think fairy gremlin residents appear from thin air to pick these patients up? No, hospitalists have appeared in academic settings because they pick up over-flow patients (non-teaching is the buzzword). Outside of the ivory towers, many hospitals are run by hospitalists.


6: re: " What motivates a med student to want to be a hospitalists? Are they frustrated administrators? Do they lack the inter-personal skills to ever have a successful clinic practice? That is why I wondered whether it is a specialty geared to foreign medical grads."

Where to begin on this uneducated and frankly bigoted paragraph? Inpatient and outpatient medicine are two very different animals. To expect one have mastered both and can stay up on both is difficult if not unrealistic. A medical resident (not medical student) is well trained to be a hospitalist, not as much so as an outpatient doctor. Is it really surprising to you that one would enter a field which one is well trained in as opposed to 1/2 day of clinic per week experience? Especially when the alternative pays less, has increased insurance hassles, has at times unrealistic number of patients per day,etc, etc. My question is why would any graduating IM resident want to be an outpatient doctor? AS far as your bias against FMG's. Many FMG's ALREADY are residency trained in their home countries. They are way ahead of US grads (I am a U grad). Many FMG's physical exams skills are way way more advanced than us technology- dependent US grads. Quit being a bigot. Just because somebody speaks english with an accent, it doesn't mean they are second rate.

7: Your issue is with Duke hospitalists (and now Northwestern). Fair enough, don't damn the whole field. Studies HAVE been done (again look it up) which have shown a modest cost benefit and at least equal care. Also PCP's aren't running from clinic to hospital and back to the point of exhaustion and financial ruin. Remember, PCP's can and do manage their own patients without hospitalist involvement (outside of the ivory tower). Maybe you need to spend a little less time dealing with the Duke's and Northwestern's of the world and a little more time looking around for a good internist who manages his/her patients in the hospital. They still exist. God love them.
December 31, 2008 1:18 AM

9. jodigirl1000 said...

Gee. You guys are very defensive. I do not pretend to be a doctor. But, I know a lot about the system.

It is beneath the integrity of a doctor to belittle passionate and intelligent people (like myself) who have been the victim of the hospital system and who have been able to identify a systemic problem. So when people such as me are on the same page as docs (I presume) --- protect patients.

To quote one of my favorite bloggers "where is the love"?

I have very good experiences with clinicians at NWU and Duke. I am just repeating the frustration that phenomenal docs at those teaching hospitals have encountered.

Pretending that the problem of "turf wars" do not exist is frankly naive.

I talk to doctors and para professionals all over the country in preparation of my graduate work.

BTW, nearly every study done about hospitalists say that the program is "here to stay" because it saves the hospitals $$. Now, EDs are starting the outsourcing.

You practice medicine. Great. I come from a long experience of med mal defense and business.

Too many doctors are telling me there is a problem. The Joint Commission agrees.

I am committed and passionate to protect patients.

I am thrilled that you are a hospitalists that communicates, cooperates and coordinates your patients' care with the admitting or attending. Sadly, it does not happen at major teaching hospitals. And that must change.

I see that this discussion has been unproductive. Instead of explaining to me why I am wrong and advocating for the hospitalist program model, you guys have just continued to insult me personally.

No point in my continuing this discussion. Good luck docs.

Peace out!!!
December 31, 2008 2:11 AM

10. jodigirl1000 said...

Ooops I forgot to mention to the esteemed hospitalists -- You are absolutely wrong that attending=hospitalist. Nope. not always true.

At many hospitals, the attending is NOT the hospitalist. The attending is often a faculty of the med school who has a clinical practice. He wants his patient admitted and he enters the patient as the attending doc in order to maintain some control. Docs such as this are trying to maintain some control over hospitalists who take over cases without communicating with the clinic docs.

The attending (not hospitalist) does not have the time to see patient every day. Okay. But since he is a faculty member at the med school, he has access to and in fact expects the residents and fellows will cover for him and see the patient.

BUT, the hospitalist gets his nose out of joint and overrides the attending and intimidates the residents. End result - attending (non hospitalist) is ignored and patient safety is jeopardized.

Doesn't that concern you hospitalists?

THOSE incidents happen routinely at Duke and other teaching hospitals. That is a problem.

Your way the system operates is not the same throughout the US. Yippe for you. Bummer for the rest of us.
December 31, 2008 2:21 AM


11. Anonymous said...

Did you show up to simply reiterate your ignorance? And yes we're defensive when you ask questions like your last bullet point. If you think that's a legitimate question without prejudice or malice, then you're just lying to yourself. It would be akin to me asking you why you started blogging in such a manner. Are you not happy at home? Have you not had sex in 4 years? Do you have some inferiority complex that you project when given an anonymous forum?

You obviously have no clue how things actually work as evidenced by your answers and assumptions. Your experiences are just that. Your understanding of why hospitalists exist is severely lacking as is your understanding of the current model. The sad part is that you have no idea how ignorant you are because you're apparently arrogant enough to believe what you spew.
December 31, 2008 6:21 AM


12. Anonymous said...

So I actually went back and read more of your tripe. You have the nerve to name people by name on a one sided forum? "Abandonment" is a strong term and is often one our batshit crazy patients use when we choose to distance ourselves from them rather than subject ourselves to the drama they cause. From what it sounds like, I can't say that I blame them if you act like this off the computer as well.
December 31, 2008 6:25 AM

2 comments:

  1. The Antihospitalist comment was meant in jest. Of course, as you know, it was a play on words.

    Of course, I also think a lot of what you write can only be extrapolated to a local systems failure.

    Like I said before, if you have concerns about the hospitalist model, one place to start would be the society of hospital medicince. They may be able to direct you to worth while literature on our value.

    ReplyDelete
  2. Thanks for the suggestion. I actually will contact the group and talk with them about my concerns with the hospitalist program model.

    Perhaps you are right and the issues are local. Then I will not have to work so hard!

    Awww, I knew you were jesting. But wow, your readers are a bit rough on me LOL.

    I hope you can appreciate that I just want patients to be safe in hospitals (esp those who are old and have no advocate.)

    If I am wrong and the model is perfect then great physicians/hospitalists should be horrified that your brethren are screwing up the reputation of hospitalists.

    Have an awesome New years!!

    ReplyDelete