When Sophia was nine months old, she was hospitalized in extreme distress at Newton Medical Center (then known as Newton Memorial Hospital) in Sussex County. Despite her young age, Sophia had a complicated medical history, and her parents didn’t know in advance that her regular pediatrician would be unable to attend her there. Why? The hospital had begun to use a medical specialist known as a hospitalist.
What is a hospitalist? Just what it sounds like: A doctor who confines his practice to a site of care—the hospital—rather than to a particular disease or organ.
Wave of the Future
The “hospital medicine” movement began in the US about 20 years ago in response to growing concerns about patient safety, rising costs, and the lack of any single hospital-based provider to coordinate the care of an inpatient, according to the Society of Hospital Medicine (SHM). The SHM explains, “…unlike medical specialists in the emergency department or critical-care units, hospitalists help manage patients through the continuum of hospital care, often seeing patients in the emergency room, following them into the critical care unit, and organizing post-acute care.”
Today there are about 11,000 hospitalists nationwide, about 5 percent of whom are pediatricians. SHM has 36 New Jersey-based doctors who describe themselves as either pediatric hospitalists or something similar in its database. There may be more, though, as they are not required to register with the organization.
Dr. Maryanne LoFrumento, a writer and speaker on childcare and development, has been a pediatric hospitalist at Goryeb Children’s Hospital at Morristown Memorial Hospital for the past three years after having had a private pediatric practice. She says, “The trend nationally is to split inpatient and outpatient professional responsibilities. The economics of hospital care versus office care are changing. It’s a disadvantage to take care of patients in the hospital.” In addition, she says, “Inpatient care is becoming much, much more complicated than when I started in practice. It’s impossible [for an office-based pediatrician] to keep up with all the best treatments for all patients.”
In fact, according to SHM, “The average US physician spends only 12 percent of his or her time with hospitalized patients. That means that the typical primary care practitioner is unlikely to see any one condition requiring hospitalization more than three times per year (according to a study by the Advisory Board in Washington, DC). Hospitalists bring to the patient a unique expertise in the care of common acute disorders. Because of their unusually deep understanding of inpatient care, hospitalists are able to recognize and diagnose disorders, anticipate problems, and rapidly respond to crises or changes in a patient’s condition.”
Hospitalists also care for patients who have no primary care doctor, and for patients who travel to large, regional medical centers where it’s impossible for their regular doctor to come see them.
Finally, hospitals themselves are bigger and more complex than ever before. Thus, according to SHM, “Many patients prefer hospitalists because they are on site 24/7 to answer questions regarding care, instead of primary care physicians who make rounds periodically. Hospitalists also know how to expedite and improve care since they are based within the hospital. They are familiar with all of the key individuals in the hospital, including medical and surgery consultants, discharge planners, clergy, and others. Additionally, hospitalists can better facilitate connections with post-acute providers, such as home health, skilled nursing, specialized rehabilitation, etc.”
Involving your primary-care doctor—>
Families and their pediatricians have a strong bond. If your child is hospitalized, you quickly have to establish rapport with a new health-care provider under stressful circumstances. “Parents have to trust the doctor they’ve admitted their child to,” Dr. LoFrumento says. “I’m taking care of the most precious thing in people’s lives.”
Still, she adds, “Involving your primary-care doctor is essential. Ask your doctor to be a liaison on a daily basis and to call the hospitalist whenever things are not clear. Your doctor speaks the language.”
And there are other ways parents can help make the process smoother. Dr. LoFrumento says, “Make sure all information is communicated from the pediatrician to the hospital on admission, and from the hospital to the pediatrician on discharge. Ask for your child’s medical records.”
When Sophia was admitted to the hospital, her mother, Debbie, says, “At first I was uncomfortable with [the hospitalist] because I felt like he did not know Sophia’s medical history and it was very involved to have to repeat under the circumstances.” However, Debbie, who is a chiropractor, came to see the up-side. Her takeaway: “Be open-minded and work closely with the hospitalist. The care will probably end up being better because the hospitalist can follow the child more closely. Request a copy of all tests, including labs and x-rays. Also ask the hospitalist the child’s exact diagnosis before they leave and write everything down to bring to the pediatrician.”
Brave New World
For what it’s worth, the hospitalist system seems to be here to stay. “Do not expect your pediatrician to come in and to this work any more,” Dr. LoFrumento says. “The office is for outpatient care. But don’t feel your pediatrician is letting you down. The world of medicine has just gotten too complicated. This system might be the best thing for your child.”
Carol Lippert Gray is a freelance writer and editor of NJ Family’s Raising Teens magazine.