Dr. Daniel Meyer (Guest): A hospitalist is somebody who is usually trained in general internal medicine, although they may have some additional training in other specialties, who primarily takes care of patients while they are admitted to the hospital with a medical issue--something like pneumonia or something like that.
Melanie: What’s the difference between a hospitalist and their physician that normally works with them?
Dr. Meyer: In some ways, not very much and in some ways, several important differences. The hospitalist could be thought of as a primary care doctor for the hospital. They are there to shepherd the patient safely through all phases of the admission while they are on a medical service. So, in some sense, they replace the primary care doctor but what is importantly different about that is, they have expertise in the issues of hospitalized patients. Medical care has gotten so complex these days that it really takes somebody who does it full time to really have the proper training and skill set. A hospitalist offers that.
Melanie: That’s fascinating. When you say hospitalized medicine, we’re talking, for the listener’s sake, about everything that goes in: the nurses, your physical therapy, your occupational therapy--everybody who works with you while you are in the hospital, right?
Dr. Meyer: That’s right and the hospitalist would be the primary person coordinating that care, whether it was reaching out to specialists when tests were needed or talking with those other disciplines you just mentioned, such as pharmacy or physical therapy, nursing, so on and so forth.
Melanie: What a wonderful service. Do they still work with their primary care physician while you are helping them out?
Dr. Meyer: Yes, that’s something I always like to explain to the patient when they are first admitted to the hospital is that we coordinate with their primary care doctor as much as possible. The primary care physicians really appreciate our service. It allows them to be in the office to see their panel of patients. What we do is when a patient is being discharged from the hospital, we reach out to the primary care doctor electronically and occasionally by telephone as well to discuss the patient’s plan of care and whatever next steps there needs to be.
Melanie: Why are so many hospitals using hospitalists now? Is this because it was, as you say, getting very complex in dealing with which hand was doing what?
Dr. Meyer: Yes, it’s primarily two things. Number one is, and most important from the patient’s perspective is, that medical care is increasingly complicated and increasingly fast-paced and having a physician who does that full-time and is in the hospital available to attend to the moment to moment changes and moment to moment decisions that need to be made about a particular patient’s care is really value added to the patient and to the hospital as well. That’s probably the primary driver for why we have hospitalists more and more today. Additionally, as I’ve said, it is a value added thing for the primary care providers as well because they used to be spread quite thin. They would be seeing a full panel of patients in the office and then also have two or three patients in the hospital. This allows them to focus on being a better outpatient doctor to their patients as well.
Melanie: What would you like the listeners to know about working with a hospitalist? As they come into the hospital, it might seem weird for them to work with a doctor that they haven’t chosen--someone who maybe they haven’t met before. What would you like to tell them about working with a hospitalist and what you would like them to do?
Dr. Meyer: I think one of the things that patients can do is be as open and straight forward with the new doctor. I think some patients are sometimes initially a little bit nervous about working with a new provider. I would want to reassure them that all of our doctors are very well trained and very well intended and very thorough and will do everything they can to take as good care of the patient as they can do. I would encourage the patients to be as open and ready to form a new relationship with a new doctor as they can be and be reassured that when the leave the hospital, we’ll make every effort to make sure that they have a safe transition back to their normal doctor.
Melanie: What about working with the family and caregivers for this person? Does the hospitalist also work with them?
Dr. Meyer: Absolutely. I learned that early on in my career that involving the family is an essential part of taking care of the patient. Particularly in Maine, where we have a large population of older patients and there is usually a support system for those patients that really needs to be involved in their care. As much as we can, we like to involve the family in the patients care. One thing that I see a lot of is, families will come to the hospital and not let the care team know that they are here and try to sneak away. We always do appreciate it when we get a call that a family member has arrived and we can come to the bedside and have a conversation with the whole family and the patient at once.
Melanie: What if now that patient is going to be discharged? What is your role in that?
Dr. Meyer: The hospitalist would essentially engineer the discharge plan. We would put together the final medication list for the patient when they are being discharged from the hospital. We would also recommend and possibly also arrange any follow up appointments or follow testing that needed to be completed. I would hope that we would also review that plan of care, not just with the patient, but also with the patient’s family when that was appropriate as well. So, on the day of discharge, sitting down with the patient and whoever else needs to be involved to review the plan of care. And, as I said before, we might even reach out to the primary care doctor and speak to them directly. But, we certainly, 100% of the time, will communicate the plan of care to the primary care doctor in paper form, if not also by phone.
Melanie: So, speaking of paper form, there’s so many confusing papers and insurance can be quite dizzying. Where does the hospitalist fit in with helping with that? Also, are you covered under patient’s insurance?
Dr. Meyer: Those are questions I try to steer clear from as much as possible. What we try to focus on is taking care of the patient and one thing that is nice about hospital medicine is, I never have to think about whether a particular patient will be covered. We provide care regardless of whether someone has the ability to pay for it or not. Just by virtue of being admitted to the hospital, we will see somebody. Ultimately, those issues are not things that I tend to worry too much about. I think from a patient’s perspective, it will all be guided by what their particular insurance coverage is. The visit of a hospitalist would not add anything unnecessary to their reimbursements, in particular.
Melanie: Does the hospitalist work with the physician to let them know these tests are being planned? Is the physician still completely involved in the whole process?
Dr. Meyer: When you say physician, do you mean the primary care physician?
Melanie: Yes, I do.
Dr. Meyer: Yes. The primary care physician would be involved depending on the situation. We definitely want the valued input of the primary care doctor who knows their patient well and who has a good long-term relationship with their patient. Those are situations where we really reach out to the primary care doctor and try to get their input on next steps and such. As I said, so much of medicine now happens in a moment to moment basis. There are so many small decisions that are made every day in a patient’s care: what labs to do, what tests to do. A lot of that decision-making might be made by the hospitalist on a daily basis and then with occasional input from their primary care doctor when needed.
Melanie: In just the last few minutes, Dr. Meyer, please give your best advice and explain to the listeners what a hospitalist is, how you help the patient in hospital and why they should come to Maine Medical Center for their care.
Dr. Meyer: I think that a hospitalist is best understood as a general medical doctor who is there to shepherd the patient safely through all aspects of the patient’s hospital stay, replacing the primary care doctor during the hospital stay with somebody who has real expertise in in-patient medicine. What that gives a patient that they might not otherwise have had, is a doctor who is available 24 hours a day to explain they key aspects of a patient’s care in a way that the patient can understand and in a way that a family can understand and to help that patient and family make good decisions about the care they are receiving and the tests that they are undergoing. I think the reason to come to Maine Medical Center for all of that is we have a wonderful hospitalist group here who is available 24 hours a day with expertise in in-patient medicine and that’s growing and improving all the time. I think patients receive excellent care.
Melanie: Thank you so much for being with us today. You’re listening to MMC Radio. For more information you can go to MaineMedicalCenter.org. That’s MMC.org. This is Melanie Cole. Thanks so much for listening.