Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Saturday, January 04, 2003
    'Ello kiddies:

    I am here in the office on Saturday night to try and get things such as paperwork and lab results out of the way and organized before next week. This is important because I am going to be the hospitalist next week, which normally is not my job.

    What is a hospitalist, you ask? Well, it's like this: six years ago when I started with my current practice, each doctor admitted his or her own patients to the hospital if they got sick, and continued to follow them throughout the hospitalization. One small problem: they don't tell you in medical school or residency how very, very difficult it is to run a busy inpatient and outpatient practice. It's hard.

    Imagine working a full-time job where you're in the office ten hours a day, on average. Now add on another one to two hours daily in driving time and rounding at hospitals: This does not include your daily commute. Add time spent on the phone during the day taking urgent calls from the hospital, or having to suddenly abandon your office and race to the hospital in case of an emergency.

    The year after I joined the group, we instituted a program whereby volunteers would take turns handling only inpatients, week by week, and would not see outpatients in their offices that week. They also took turns admitting patients at night; I can't tell you how wonderful it is to be able to hand off an admission to somebody else when it's two o'clock in the morning. This, as you can imagine, lifted quite a burden from us. Slowly, in the years since we began this program, about ninety per cent of the doctors in the group have turned their inpatient practices over to the hospitalists. (The hospitalists are reimbursed for their extra duties, in case you're wondering why anyone in their senses would agree to this.)

    I know the patients would prefer to have their own docs look after them in the hospital, but to put it bluntly, we don't want to do it any more. It is backbreaking work and it cuts our already limited free time even further. If you have young children it is very, very difficult to round on your patients in the early morning, for instance. I do not have that problem, but I have begun exercising with a trainer and walking with my next-door neighbor on weekday mornings, and if I had to round on patients in the morning it would be very difficult for me to continue with my exercise program, since I start seeing patients at 8:40 am. And believe me, I need the exercise.

    I know I've blathered on too long about this, but to come to the point, the hospitalist group is starting to burn out. We hired one doc specifically to handle the inpatients (he doesn't have an outpatient practice) but he got sick about six weeks ago, requiring surgery, and is still out. The group has been casting around desperately for replacements, and I am one such, for the next week. I will try to post some dispatches from the front lines.

    I don't know how bad this is going to be; hopefully not too bad, but our main admitting hospital has just instituted a computer program for admissions orders. I had a brief experience with it New Year's Eve, and it's just awful. More details later.



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