- THE HOSPITALIST: Dr. Bean on call.
What if you, during a stay in the hospital, knew that your internist was never farther than five minutes away? That you would know the results of blood work and X-rays quickly, and that your family would too, without having to make a 5 a.m. trip to the hospital to catch your doctor on rounds?
What if this hospital-based doctor made a visit by a specialist unnecessary, saving you extra tests or time in the hospital?
What if you could go home when you were ready instead of having to wait until your doctor had time to come to the hospital to discharge you?
You’d be a happier patient. Your insurance company might be happier, too. It’s a wonder this new development in medicine — care by a hospitalist internist — is only just now making its mark on American healthcare.
Hospitalists — internal medicine doctors who work primarily in a hospital rather than from an office — are the fastest growing group of doctors in the country. When the field was invented on the West Coast a decade ago, there were fewer than 1,000 hospitalists. Today, there are 12,000.
“Mark my words,” said Dr. Eric Bravo, a hospitalist affiliated with Baptist Health, “10 years from now even specialists are going to have hospitalists. It makes so much sense.”
Primary care physicians are thrilled with the arrangement, said Bravo, 34, who’s worked in Little Rock with Internal Medicine Associates for the past six years, and Dr. Brian T. Bean, 32, who is employed by St. Vincent Infirmary Medical Center. Family practice doctors can see patients at their offices and avoid having to round at several hospitals.
Emergency rooms at Baptist and St. Vincent maintain lists of hospitalists that primary care doctors — and, increasingly, specialists — can call on to act as their surrogate.
Family doctors know their patients, have a relationship. So it’s crucial, Bravo said, that the primary care doctor make his patient’s pertinent medical and pharmaceutical information immediately available to a hospitalist when his patient is admitted. After the patient is discharged, the hospitalist must communicate to the primary doctor what the patient’s follow-up care should be. Communication is “fundamental,” Bravo said, for the system to work.
Problems can arise — a patient admitted during the weekend when his primary care doctor is unavailable may have to repeat tests he’s already undergone to get quick results to the hospitalist. But as Bravo pointed out, that can happen anytime one’s doctor isn’t on call and a medical history can’t be found.
While the hospitalist might not have the breadth of experience of an office doctor, he may have a deeper knowledge of certain illnesses.
“Nobody sees more pneumonia than a hospitalist,” Bean noted, and the hospitalist may be able to treat a stroke or a cardiac patient without having to call in a neurologist or a cardiologist. Bean and his colleagues at St. Vincent — Drs. Sharif Ibrahim and Rana Kayali — often work with surgeons to lighten their load pre-op and post-op, Bean said.
“You might say we’re a jack of all trades,” Bravo said.
Those factors add up, studies say, to shorter hospital stays and lower costs for both patient and payer. Even better, Bean said, research suggests that hospitalist patients have lower short-term mortality rates.
Bean, who did his residency in internal medicine at the University of Virginia School of Medicine, and Bravo (Northwestern University in Chicago) were drawn to the field because of the greater challenge in taking care of acutely ill people.
Bravo sees on average between 20 and 25 patients a day; Bean 12 to 18 patients a day. Bean sometimes regrets that his encounters with his patients are so limited; he may never see them again after he gets them well. But, he added, “after one serious visit, you can establish rapport.” He wants his patients to “feel they’re heard.”
Bean took a reporter on part of his rounds recently, stopping first in the room of George Gleason of Bryant. Gleason, who’s retired, was being treated for a wound that had ceased healing and begun to spread infection to his bloodstream, a potentially life-threatening situation. Now in St. Vincent’s skilled nursing care wing after several days in the wound care center, he was sitting up, looking good, even complimenting the food. Bean, he said, “is on top of everything all the time.”
Bean next looked in on a woman suffering from sickle cell anemia, an incurable and painful genetic disorder that causes stressed red blood cells to curve into sickle shapes and stop providing oxygen to the body. Carol Thomas, 27, lay quietly under a sheet, uncomplaining, but her pale lips and stillness betrayed her illness (and her painkillers). She’d had to have a blood transfusion — her third in 12 months, she said.
Thomas told Bean she wasn’t feeling as well as she’d been the night before. He told her he’d looked at her blood culture and seen a high white cell count. He reassured her it was from a skin bacteria around her IV line and not something more serious. He assured her the hospital would get everything under control.
In Thomas’ case, “I have to come in and look at her” to provide her the best care, Bean told the reporter. Paperwork alone in Thomas’ chart couldn’t tell him everything he wanted to know.
Bravo said he knows resident neurologists who plan on limiting their practices to hospital care, and he expects to see cardiologists to join the field.
On Baptist’s list of primary care doctors who use hospitalists, “not one of them has said he wants to come back,” Bravo said.
“The movement has grown because the hospitalist loves his job,” Bravo said, and “the primary care physicians who don’t have to go to the hospital are happy.” Emergency care doctors don’t have to wait for hours to get a patient admitted. Patients get well in a shorter amount of time. “Everybody wins.”