Why isn't Larry's oncologist calling me back? Why is the Dr who visited Larry on Sat and Sun still here on Monday? Why is she making medical decisions WITHOUT talking to his oncologist? Who are these Dr's who keep visiting Larry with all these very scary assumptions? What the hell is a HOSPITALIST DR????
I must have asked that last question a dozen times over the last few days, attempting to understand. It was as if my mind could not accept this new method of medical care for patients in a hospital. This morning I called the other area hospitals to see if they had the same practice. Has the medical community gone mad or have I.
Primary care doctors, your family Dr, or your Oncologist, Cardiologist, no longer make patient rounds if you are in the hospital. The medical community has now decided that Dr's are overwhelmed with the number of patients they have, so are easing their load by taking away contact with their patients who are hospitalized.
They now employ Independent Hospitalists who handle in patient care. North Shore University Systems has an all online medical history system, so a Dr. who knows nothing about you can read your history.
Now, my reaction here is very personal, since the last 3 1/2 days have been hell. Yet when I cannot get Larry's Dr to return my call that means there is a big problem. I know where he is today and I am very close to deciding if I should stop by his oncology dept and request an immediate consult.
The Hospitalist Dr who is handling Larry's case is very nice, but that is not the person we chose as our Dr. I do not know anything about this Dr. She is not listed on their website of Dr's. When she starts making decisions that effect his health, like deciding which antibiotics he should be receiving by IV drip or choosing to eliminate one of them, my anxiety level reaches an unhealthy level. I then have to immediately access what is happening and dig deep as to what questions have to be asked. Is my voice calm, no. Am I being as nice as she is, no. Am I stressing my hubby out more, a big yes!
This situation has changed my confidence in North Shore being able to give Larry the quality of care that he needs. Damn, we do not need this feeling of loss of confidence at this time!
Mel, I am sorry you guys are having a difficult time there.
ReplyDeleteSo, here is the low down on hospital care. All/most hospitals now employ "Hospitalists" to do inpatient care. It is not the medical community that decided this - you can thank the insurance companies that stopped paying for primary care providers to do this service.
In addition, with patients going to the hospital of their choice - each provider would have to have privileges at each hospital in order to see patients. Not only is this too difficult with travel time to see one patient here, one patient there, etc, it is also expensive and time consuming to maintain those privileges and you have to provide coverage for when you are not able to show up - and drives malpractice insurance premiums up. In Lexington we have 8 hospitals - and we are considered a small town/city. Our practice gave up inpatient admission privileges about 10 years ago.
Hospitals now employ these teams of providers - PAs, NPs and MDs to provide inpatient care. Sometimes they are employees of the hospital and sometimes - more often then not - they are staffed by independent contractor companies to provide coverage. Usually these providers are "on 24/7" for 7 days then off for 7 days. I am sure there are other schedules but those are the typical schedules around Lexington.
In order for the Oncologist to see Larry - the Hospitaltist needs to to ask for a formal consult from them. If Larry was admitted by the Oncologist then he is considered his patient, however, if the Hospitalist admits Larry, then the Oncologist is only a consulting physician unless care is transferred over to them. Hopefully and ideally they would work and communicate together to coordinate the best care for him.
I understand and feel your frustration with hospital care. We, primary providers, are often in the dark about what is going on at the inpatient level. I have the same level of anxiety when I hand over a patient to "someone" that will take over their care. There are some hospitals that I refuse to admit patients to, because I dont trust the hospitalists that work there and I am tired of cleaning up their messes.
The turn over for the hospitalist positions is high because of the hours/stress and burn out - so you never know who you are admitting a patient to - and then what is more frustrating is that the patient may see one provider for a few days and then a different one for a few days. It is very difficult to build trust and communication with someone to have them leave and a new person come in. Continuity of care is hard to come by and YES - it sucks!
The issue with the Oncologist not returning your calls is disturbing and what I would consider unacceptable.
Thanks for info, Laurie!
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