A Desperate Caregiving Moment

The New York Times recently published an article extolling the virtues of a new kind of medical specialty, the hospitalist.  This “new breed” of doctors works exclusively in hospitals with hospitalized patients.  The hospitalists with whom I have had contact are members of a group practice that contracts with the hospital to provide medical coverage throughout the facility.

One supposed advantage of this system is ease of oversight of all the patient population freeing up primary care physicians to focus on their outpatient practice so that they are not inefficiently dividing their time between hospital and clinic.  In theory, hospital doctors are more available to patients than their primary care doctor might be.  Studies show that under this system hospital stays are reduced by 17 to 30 percent and medical costs by 13 to 20 percent.  Doctors earn up to $30,000 more a year than they might in private practice.  Everybody’s happy, right?

Not so much.  When my then 90 year old father, Frank, was hospitalized a year ago, we had our first experience of the hospitalist system.  Frank was very ill for three or four days with pneumonia on his first admission.  We met his doctor the first day during our visit to Dad.  I was surprised that he had a different doctor the second day.  I was really surprised that he had a third doctor on the third day.  Thus began one of my most desperate moments as a caregiver of my aging parent.

Dad was still very sick when this third young doctor diagnosed him with “profound dementia” on the basis of his lack of responsiveness.  When I told the doctor that Frank’s memory problems were on the mild side and that I thought he looked like this because of his illness, the look I got said it all:  the family are in denial.  This doctor went on to say that “Frank is trying to tell us something” by this severe illness, and that I should “prepare to let him go.”  Doctor Number Three was not there the next day, when Dad’s antibiotics finally kicked in, to see him sitting up in bed energetically asking questions about every aspect of his care.

Reading Jane Gross’s very positive report on the specialty in The Times, I thought I must have had an unusual experience.  Then I read the synopsis of her report in The Times’ New Old Age Blog accompanied by reader comments.  Wow. The vast majority of the 44 comments posted so far relate negative experiences of patients under the hospitalist system.  Many of these comments are long and emotional.  As far as I could see, only two of the positive comments were from patients who had had a very good experience with hospitalists.  The rest were from medical professionals, the most egregious in my opinion from a primary care doc who likes hospitalists because now he no longer has to interrupt his office schedule to run over to the hospital when one of his patients has an emergency. Good for him, but maybe he ought to look more deeply into the quality of care his patients may be receiving.

If, as some say, the hospitalist system is here to stay, in many instances these doctors appear to have a long way to go to begin to provide the quality and continuity of patient care that should be their primary reason for being.

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