Dr. Elizabeth Herrle (Guest): Hello Melanie, thanks for having me. It's a common question and one that I get over Thanksgiving Dinner pretty much every year. For folks who don't know, a hospitalist is a basically a doctor who specializes in taking care of patients who need to be admitted to the hospital. I'm an adult hospitalist, but there are also pediatric hospitalists who specialize in hospitalized children.
Melanie: So does this benefit the patient and if so how?
Dr. Herrle: I'm a little bit biased obviously being in this career, but I do believe it has strong benefits for hospitalized patients. To understand the benefits, you have to look at the history of the field a little bit. People are probably more familiar with an older model where you have a primary care physician who sees you in the office and then if you are admitted to the hospital, they come into the hospital and they see you in the hospital. That certainly has its advantages, but it does put a strain on both the care that you receive in the office and the care that you receive in the hospital, because your Doctor can't be in both places at once. If you become sicker while in the hospital and your physician is in the office, that's obviously going to be a problem.
Melanie: Can they still see their primary care physician while they are seeing you?
Dr. Herrle: They absolutely can! That can happen in different ways. Sometimes primary care physicians will come into the hospital and do a consult level where they see you and write a full note in your chart. Other times, it's more of a social visit that they will come in for. Or even just touch base by phone.
Melanie: So then, as the hospitalist, how do you work with the nurses and staff to assure that the patient gets the best care?
Dr. Herrle: We work very closely with the nurses. The nurses tend to be right there with you in the room every step of the way. Most nurses are either assigned to 2 or 4 patients, at a time and most hospitalists are assigned from about 14 to 20 patients at a time. So the nurses are able to see if right there and be a first line assessing you if something changes in the hospital or if you have a need. They are able to communicate directly with us about what those needs are and some of that we're able to address over the phone. You know if you need a new medication for perhaps a patient or something like that. All the way up to you're getting a whole lot sicker and we need to come to the bedside and provide additional care.
Melanie: Who do you like to tell patients about engaging in their own advocacy? So that they can know what's going on with their health.
Dr. Herrle: Well I think that's incredibly important. The more you know about your own health, the more you're able to co-operate with your health-care team in the hospital and ensure that your transition between the hospital and your home, and getting your care back to primary care physician is as safe and complete as possible.
Melanie: What do you like them to bring to the hospital, when they're coming if they know that they're going to go?
Dr. Herrle: Well if you know that you're coming in, one thing that does really help with the transition is to have a record of the most important medical issues that you have, the doctors that you see outside the hospital, including any important specialists that you have regular contact with and very importantly the medications that you are taking including your dose and how often you take them and if you know what you are taking them for.
Melanie: And then, how can clinical staff help to prepare patients for discharge early on their hospital stay to help make that process a little bit easier on the patient?
Dr. Herrle: You'll see if you do have to come into the hospital, right early on generally from either the first or second day that you're there you'll be meeting with one of our care managers. These are professionals who can either have a background in social work or nursing who have done additional training to become specialists in preparing people for transitions out of the hospital. So depending on what your needs are going to be after the hospital, they may help you with things. For things that are straight-forward as making sure that your insurance is going to cover the medications that you go home on all the way up to helping you or a family member to secure a place to go, if you need ongoing nursing care or placement in a memory care facility for Alzheimer's. So they do a broad range of services depending on your needs.
Melanie: Then where does the family fit into this picture? What do you tell patients about their family being involved in their health care?
Dr. Herrle: I'm always happy to see an engaged family member at the bedside. It's really hard to be a patient in the hospital. By definition when you are in the hospital, you're sick and you're feeling unwell and you're not always able advocate for yourself or remember all the details of what has happened to you, because there is so much happening so quickly and you're not your best self at that time. So, having another set of ears and another person who can advocate for you, look after you and keep track of the information coming to you during the course of your stay is very important. I always tell people when they come into the hospital, if they have a family member who comes and wants to talk to the doctor, no need to wait around let the nurse or unit secretary know that you're looking to talk to somebody and they'll let us know that you're there. Because that’s the best way for us to know that there is someone looking for an update from the care team.
Melanie: Dr. Herrle, which questions do you advocate that patients ask? Whether it's the hospitalist or their nurse or even their physician. What do you like them to ask so that they know what's going on?
Dr. Herrle: So, I think that starting from the basics is really important and while you're admitted a lot of things change particularly in terms of your medication. I say if you have any question about somebody has handing you to take and put in your body, be sure to ask what is this pill, why have I been prescribed this? And make sure you know what medications you're getting. As you're getting closer to discharge, the things you want to is what is my diagnosis as I'm leaving the hospital, what is the main thing that you were treating me for, how are my medication going to change going forward and what follow up do I need, who do I need to see after I leave the hospital?
Melanie: And patients that have a planned procedure, have many questions about anesthesia and pain management afterwards. What do you tell them about those things?
Dr. Herrle: So in our role as a hospitalist we often do overlap with our surgical colleagues and assisting patients who have complex medical needs around the time of their surgery .The team also collaborates very closely with our colleagues in anesthesia. So anyone who is going for a procedure, is going to have a pre-operative evaluation with an anesthesiologist who specializes in that field and those would absolutely be the people to bring up those questions to. Post-operatively most pain management follows a pretty difficult course and there's medications that are made available on a routine basis to the vast majority of people after surgery but if things become a little more complicated or pain management isn't effective we will collaborate directly with the surgical team around pain management. Or here at Maine Medical we have a dedicated pain management service that can be brought into consult on more complex cases. So if you're hurting and you're not able to function after surgery in the way that you expected definitely let us know and be vocal about that.
Melanie: So, wrap it up for us in the last few minutes with your best advice for people that may have to be admitted to the hospital and so that they're not so nervous about it. Give them some hope about it and tell them what they can expect
Dr. Herrle: It's a tough question because everybody's course is so different! But what I will say is that we want you to be informed and engaged and to know what's happening and I think in a busy practice in the hospital, it's always helpful to have reminders from patients and their families. We can come into a room and explain things wonderfully and maybe if you have a question then you don't want to be a bother; don't want to be labeled as difficult or something like that. I would say just put that fear right out of your mind and let us know if we said something that you didn't understand or you have a follow-up question and we haven't completely done our job and we want to know that and we want to do the best we can to communicate the best information to you, so that you can participate fully in your health care. So, speak up and say something! We're happy to answer your question at any point.
Melanie: Thank you so much for being with us today Dr. Herrle. It's great information. You're listening to MMC Radio and for more information you can go to www.mmc.org. That’s www.mmc.org. This is Melanie Cole, thanks so much for listening.