Thoughts Raised by the Article 'Hospitalists and the Decline of Comprehensive Care'

September 29, 2016

According to a recent article in the New England Journal of Medicine (“Hospitalists and the Decline of Comprehensive Care,” September 15, 2016), the hospitalist model has provided such benefits as reductions in length of stay, cost of hospitalization and readmission rates – all hospital-defined metrics.  But what is its impact on overall health, total costs and, most critically, its benefit to patients?

I see several issues raised by this increased reliance on hospitalists.  Most importantly, it can be highly disconcerting for patients to discover that the physician who knows them best will not be able to see them at their moment of greatest need — when they are in the hospital, facing serious illness or injury.  Isn’t it much better for patients in these situations to be talking to someone they trust and who knows them and their medical history?

In addition, as the number of physicians caring for each patient increases, the depth of the relationship between patient and physician tends to diminish — a sad counterpoint to the patient–physician relationship as the core of good medical care.  This also creates greater opportunities for miscommunication and discoordination, particularly at admission and discharge, between community physicians and hospitalists as well as between hospitalists and other hospitalists. The result may be failures to follow up on test results and treatment recommendations.

Finally, as community physicians treat hospitalized patients less frequently, their skills in hospital care may decline, while hospitalists who never see outpatients may never understand patients’ lives outside the hospital.  This fragmented patient care model may cause physicians to find it more difficult to provide truly integrated care.

In my view, the key to comprehensive patient-centric care is communication between doctor and patient and knowledge of the patient’s condition and past treatment.  By their very definition, hospitalists are not in this position and their utilization does not assist in the necessary communication of patient information to ensure comprehensive, patient-centric care.