Transitions between the hospital and home are perhaps the Achilles' heel of hospital medicine. Care becomes fragmented as patients are handed off from hospitalist to their primary care doctors, and patients can become confused about who's in charge.
Let's talk -- or not
Communication and coordination are critical to a smooth and safe transition between settings -- and doctors. But things don't always happen the way they should. A 2007 study published in the Journal of the American Medical Assn. found that direct communication between hospital physicians and primary care doctors occurs less than 20% of the time. Typically, primary care physicians rely on written discharge summaries for information about their patients' hospital stay. Unfortunately, these summaries frequently lack important details such as diagnostic test results and a list of discharge medications.
Hospitalists say patients seem largely willing to accept the trade-off -- that they'll be cared for by an unfamiliar doctor but one who can be by their bedside. "Given the forces at play, I think people understand that it's a more logical way of doing things," says Wachter.
I'm not sure I'd be terribly accepting of a doctor I have no history with and little knowledge of, particularly if I was sick enough to be hospitalized. I invest a lot of time and energy into the process of selecting my physicians and like the ones I've found.
Nonetheless, it appears that hospital medicine is here to stay and that the time might come when I'll have to. If it does, I still won't accept anything less than the very best -- but it will just have to be the best hospitalist or a hospital that picks the best hospitalists.
Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.
themd@att.net
