Monday, December 29, 2008

Hospitalists interfere with graduate medical education

I sent a letter to the Accreditation Council for Graduate Medical Education (ACGME).

I think there is a problem with accrediting graduate medical programs where the graduate medical students will be undermined and pushed aside by hospitalists who are simply uninterested in the advancement of medical research and education.

I appreciate your position in accrediting graduate medical education. And I am trying to appreciate the relevance of the hospitalist program model in a teaching hospital (such as DUH).

What I have experienced over the course of several years is concerning. I routinely interact with hospitalists at DUH who tell me that they do not work with the residents, fellows or even attending/admitting Duke Medical faculty. And, of course, a DUH hospitalists will not cooperate, communicate or coordinate with the Duke Clinic physicians that have actually treated the patient.

My experience has been that the Duke residents have terrific clinical and inter-personal skills with the patients. And on a Friday night, the resident is rolling solo and does not have to deal with the hospitalist. The resident or fellow will recommend and order what seem to be valid tests and tx.

But, then on Saturday morning, the hospitalist enters and actually tells me (this has happened many times and at many admissions) that she or he does not take orders from ANYONE. The resident is pushed out.

At the end of the day, the residents' clinical judgments have been on point. And the patient is re-admitted with a worse medical situation --- the problem and readmission would have been unnecessary if the hospitalist had not been so concerned with "turf" and had listened to the residents.

I know your organization wants to protect the incredible number of hours that medical graduates work. But please do not jeopardize patient safety, health and continuity of care in the teaching hospitals by blindly relying on hospitalists.

Thank you for your consideration and time.

I truly hope that someone, somewhere takes notice of the detrimental effect of the current hospital program model. The concept of "hospitalists" (especially in the teaching hospital environment) will never work until and unless there is a implementation of the "3-Cs" --


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