Tuesday, July 14, 2009

Hospitalist = Stranger Doctor = Obama Care

I am beginning to feel like a broken record but here I go again - when you are admitted into a hospital in the United States you will be evaluated, triaged and maybe treated by a virtual stranger doctor (unless, as with many patients in this defective system, you are have a quick readmission)!

The concept is called "Hospitalist Program Model."

I have been told by well respected physicians that the hospitalists system (when run properly) provides excellent care to the patient. These same physicians tell me that private clinic physicians actually do not want to be bothered following the patients in the hospital. According to advocates of the Hospitalist Program Model, the hospitalists are in fact doing our personal docs a favor. How can we argue with that? We like and trust our private doctors.

Okay. Reality check.

1. The Hospitalist Program Model was thrust upon both patients and private clinic physicians in order to get patients the heck out of hospitals and save the hospitals money.

Many people who have not been in a hospital within the last 15 years actually expect their own doctors will follow them and make major medical decisions (include discharge decisions) if they were to be hospitalized. Isn't that cute?

The hospitalist gets bonuses and keeps the job is they can get patients out within a couple of days. This is accomplished because the stranger doctor considers the presenting problem. In my experience, that doctor does not want to be bothered knowing you 10 or 60 years of medical history. The stranger doctor evaluates your presenting medical condition in terms of a "snap shot picture" instead of a "motion picture."

I believe that evaluating the patient's medical condition in terms of a snap shot picture results in medical errors and quick turn-around re admissions. That wastes precious medical resources and money. (This blog is replete with multiple, tragic examples of how hospitalists at Duke University Hospital in Durham, North Carolina bluntly and frankly ignored the orders of admitting Duke Clinic physicians and surgeons and the result was serious life altering medical complications and deaths).

I was told by a hospitalist at Duke University Hospital that the hospitalists rotate to different rooms on each Saturday morning - because certainly no patient should still be in a bed on a Saturday morning. Saturdays are an unwritten discharge date (according to this DUH hospitalist) because DUH needs free beds for Saturdays (emergencies and scheduled surgeries).

2. The Hospitalist Program Model is designed to get patients used to having major medical decisions made by a stranger. As patients thrown into Obama care, it will been essential that we accept medical decisions being made by strangers (whether in your hospital room or in a government office perusing your medical records.)

A fundamental aspect of Obama Care is "The Federal Health Board" and it is clearly described in Former Senator Tom (didn't he lose re-election for a reason) Daschle's horror book "Critical" on pages 141-180. (Daschle is much like a Gitmo detainee - his home state won't take him back and so he has been released into general society).

Do not be sucked into the liberal Obama Care-ites' argument that medical decisions are already being made by strangers in insurance offices. Poppycock.

State and federal legislatures have enacted laws to protect patients when insurance companies deny medical care in bad faith.

In contrast, Obama Care will not protect patients from Obama Care strangers. Obama Care will dangle a carrot (or cigar) in front of physicians' noses.

(a) Cooperate with the federal health board directive and you will get paid.

(b) Cooperate with the federal health board directive and you will be immune from any medical malpractice suit.

Sweet, huh?

3. There has never been a reputable study that addresses whether the Hospitalist Program Model

(a) provides satisfactory care and appropriate follow-up care to patient;

(b) results in early re admissions related to the initial admission;

(c) is properly standardized so that "Hospital A" utilizes the system essentially the same as "Hospital B";

(d) is preferred by the patient as opposed to having direct contact and major medical decision making directed by the admitted/patient's primary doctor; and

(e) is the preferred method of care by the admitting/primary doctor and, also in that regard, whether the primary physicians are satisfied with the communication, coordination, cooperation and continuity of care for the hospitalized patients when hospitalist is involved.

I have contacted the research group of Frank Luntz and Michael Maslansky to suggest this would be important research. I hope someday this reputable group provides a service to our country by carrying out the research.

I actually do not believe that the treating physicians want to pushed out of the patient care once his or her patient is hospitalized. Sure, making rounds is a hassle. But, in the cases with which I am most familiar (Duke University Hospital), there are interns and residents.

I have been told by a DUH hospitalist that could barely speak English that she was in charge and she would over-rule any intern or resident. That was August 2008. Her arrogance caused my dad to suffer for the last year (and me to be out of work caring for him for the last year)! Her arrogance missed a basic infection that the interns and residents at DUH would have undoubtedly diagnosed.

At least 6 surgeries later, my dad is in pain every day and is scared to death. He is a Stage Four cancer patient and is 76 years old. The thought of dad being a part of Obama Care crushes my heart.

I write this blog and bang as many pans as I can about the dangers of the Hospitalist Program Model" because I never want anyone to see their daddy suffer as I have.

People, there is no free lunch. You cannot get free health care and then expect free state-of-the-art medical care. Free health insurance does not mean perfect health care whenever you want it! In addition, there is no Santa Claus and there is no Easter Bunny. (I have health insurance and have been waiting for orthopedic surgery for 5 years!)

BOTTOM LINE:
The further the distance between the patient and the physician in the medical care relationship, the less likely that the patient will enjoy a positive outcome. That is only logical. And Obama Care seeks to widen the distance between the patient and the physician.

How can Obama Care first widen the gap between patient and physician? Hospitalist Program Model

We can stop this. We can return to the relationship directly with our doctors. It is that relationship that provides valuable medical miracles and medical advances.

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