Medical Author: Siamak Nabili, MD, MPH
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
If you have or someone you know has recently been admitted to a hospital, chances are that they were not seen by their primary care physician in the hospital. As a result, many patients ask questions such as:
- Where is my doctor?
- Why isn't my doctor here to oversee my healthcare while I'm in the hospital?
- How does my primary care physician know that I am in the hospital?
- Is my own doctor going to be updated about my care?
So, why isn't your primary care physician overseeing your care while hospitalized?
The reason is a relatively new trend in the care of hospitalized patients. Hospitalist is the term used for doctors who are specialized in the care of patients in the hospital. This movement was initiated about a decade ago and has evolved due to many factors. These factors include:
- financial strains on primary care doctors,
- patient safety,
- cost-effectiveness for hospitals, and
- need for more specialized and coordinated care for hospitalized patients.
Most hospitalists are board-certified internists (internal medicine physicians) who have undergone the same training as other internal medicine doctors including medical school, residency training, and board certification examination. The only difference is that hospitalists have chosen not to practice traditional internal medicine due to personal preferences. Some hospitalist physicians are family practice doctors or medical subspecialists who have opted to do hospitalist work such as, intensive care doctors, lung doctors (pulmonologists), or kidney doctors (nephrologists).
There are many advantages of hospitalists in the care hospitalized patients. One advantage is that hospitalists' have more expertise in caring for complicated hospitalized patients on a daily basis. They are also more available most of the day in the hospital to meet with family members, able to follow-up on tests, answer nurses' questions, and simply to deal with problems that may arise. In many instances, hospitalists' may see a patient more than once a day to assure that care is going according to plan, and to explain test findings to patients and family members.
Hospitalists also coordinate the care of patients' in hospital and are "captain of the ship." They are the physicians that organize the communication between different doctors caring for a patient, and serve as the point of contact for other doctors and nurses for questions, updates, and delineating a comprehensive plan of care. They are also the main physician for family members to contact for updates on a loved one.
Similarly, because hospitalists are in the hospital most of the time, they are able to track test results and order necessary follow-up tests promptly. This is in contrast to the traditional setting where your primary doctor may come to the hospital the next day to follow-up the results and take the next necessary step at that time.
Since the hospitalist's "office" is the hospital, and they are also more familiar with the hospital's policies and activities. Many hospitalists are involved in various hospital committees, and assist in improving important areas such as patient safety, medical error reduction, effective communication between physicians and staff, and cost effective patient care.
The main disadvantage of having a hospitalist take care of you in the hospital is that, they may not know your detailed medical history as well as your primary doctor. Another problem is that your primary care doctor may not have access to the details of your hospitalization care (tests, procedures, results, medications, medical plan of action, etc.). These problems have been dealt with to a degree by communication between the primary care doctor and the hospitalist, which usually, and ideally, takes place at least twice during a hospitalization, once upon admission and again prior to discharge from the hospital.
So next time you or someone you know are admitted to the hospital, do not get offended that your primary care doctor will not be caring for you in the hospital. Rest assured that the hospitalist doctor rendering the care has the qualification to provide you optimal care during your hospital stay.