What is a Hospitalist?

Initially appeared on vox.com on 9/4/2008.

When i tell other people what i specialize in, they often come away looking a little confused. I try to explain it as simple as i can: "I'm a hospital-based doctor, i do rounds on patients all day," but it still seems hard to conceptualize. This is especially baffling to Filipinos, who are used to having their own personal doctor manage all the aspects of their medical care - outpatient, inpatient, and even ICU.

Again, an explanation:

A "Hospitalist" is a hospital-based (i.e. no office or clinic) doctor who specializes in acute inpatient care. Often, office-based doctors are so busy seeing up to 40 patients a day that it is sensible to leave the more complex inpatients to the care of another doctor - usually a specialist in Internal Medicine. These days, so many things can be managed on an outpatient basis that (generally speaking) only the sickest of the sick are actually admitted to the hospital and require more care than just someone rounding for 15 minutes early in the morning and being sporadically available for follow-up on new issues during the day.

The Hospitalist philosophy remedies this by having the physician in-house for most of the day. That is, if somebody is "crashing" or if families want to meet to discuss plans of care at a convenient time, the doctor is always just a few minutes away and able to drop everything if needed. In contrast to the office doc, who may need to cancel 4 appointments to drive in and see the patient, or just see them at either the beginning or end of the working day (which could be inconvenient for families and discharge planning).

In addition, there are certain practices that are almost constantly "in flux" and require that the doctor be frequently updated. Examples on the outpatient side are screening guidelines and management of chronic conditions, while examples for inpatients would include tight glucose control and venous thromboembolic disease. Having one doctor focus on outpatient care and one focus on inpatient care makes sense in that each is able to follow the voluminous amount of data for their own area frequently - which leads to better patient care. In the same way that many patients are seen by a Cardiologist for heart trouble, they are also seen by a Hospitalist for their hospital stay.

In using this analogy however, note that as most cardiac cases can be handled by a competent Internist (not necessarily a Cardiologist); most inpatients can also be handled by the outpatient docs. It's more a matter of physician (and of course, patient) preference.

Having a Hospitalist care for you in the hospital does not mean that the primary care doctor is out of the picture; on the contrary, they often communicate frequently for transfer of information and always (at least for our practice) send a letter after you are discharged summarizing what was done and what else needs to be followed up on. Everything is done to minimize miscommunication and keep everything within the same "continuum of care."

I hope that helped. Questions are always welcome.