If you've been hospitalized in the past two decades, a physician known as a hospitalist probably delivered some of your medical care. Most likely, this doctor was not someone you knew before you became a patient.
This specialist in hospital medicine is:
- Typically board certified in internal medicine.
- Part of a specialty that always has a doctor on duty in the hospital, 24 hours a day.
- Familiar with a hospital's standard procedures, systems, organizational model and personnel.
Today, more than 50,000 hospitalists practice in the U.S. They typically practice only in hospitals and generally don't maintain an office to see patients.
"You can think of a hospitalist as your primary care physician while you're in the hospital, albeit only for the duration of your stay," said Christopher King, MD, a hospitalist who is an independent member of the HonorHealth medical staff. Like most hospitalists, he's employed by a group of physicians who then contract with hospitals. Dr. King's group is called Affiliated Hospitalists.
"We generally only care for patients in the hospital setting, but there are some hospital doctors who do have an outpatient practice as well," he said.
In years past, it was common for family physicians to continue caring for their patients when they were hospitalized. "Today," Dr. King said, "that is a rarity. However, some ‘concierge' doctors — those who charge monthly fees for more personalized care and who have smaller private practices — often do still play this dual role, but even that is becoming a thing of the past."
Solving diagnostic puzzles
Most hospitalists choose this specialty because they like the idea of being a "generalist, solving diagnostic puzzles that are not limited to one type of problem or organ system as a specialist would," Dr. King said. "Our holistic approach to your care ensures that the rest of your longstanding medical issues are taken care of so that consultant specialists (cardiologists, pulmonologists, nephrologists, infectious disease specialists and surgeons, for example) can focus their core of deep knowledge in their respective areas of your acute issues."
Dr. King likens a hospitalist to a quarterback. "We are the chief communicator of your hospital team. We put together the team of specialists who will treat you and then act as advocates for you by coordinating care among them. We can only succeed if we not only have every physician on that team on the same page but also (and most importantly) help you understand in plain English what treatment is going to entail. If you feel both well-informed and invested in the plan of care, we have done our job."
Hospitalists are also "the key to your successful transition out of the hospital," Dr. King said. "This usually includes making sure you understand the value and importance of close follow-up with your regular doctor and any specialists to ensure that you stay well. We really do want to promote good continuity of care. That's why we ask that you follow up with your primary care physician if you've been in the hospital for a significant illness — usually within a seven- to 10-day period after discharge while the details of your visit are still fresh in your mind."
This isn't simply a suggestion, Dr. King emphasized. "It's a necessity and a prescription for success to prevent rehospitalization."
A primary care physician also is essential because a hospitalist will give you only a limited supply of most medications. This can include antibiotics, pain medications and any other new prescriptions when you're leaving the hospital. "In order to get refills and longstanding medications you take regularly, you absolutely must have a community primary care doctor," Dr. King noted.
A hospitalist cannot give you additional refills, "as we do not continue to see you outside the hospital to monitor for side effects," he said. "What we can do is make recommendations if you need to find a good primary care physician."
What to do now, before a future hospitalization
Before you're hospitalized again, it's crucial to:
- Entrust medical power of attorney to someone who can make decisions for you if you're incapacitated. (See advance directive information.)
- Discuss your specific wishes about resuscitation with that individual.
- Talk about a do not resuscitate (DNR) order, or full resuscitation (known as "full code") preference.
"Please document this person's name and contact information and carry it with you," Dr. King advised. "Getting this done today will ease your mind at the time you need it most, before an unexpected hospital admission. You'll be fully prepared, and your hospitalist may actually hug you for bringing this information to his or her attention."