My family's experience with hospitalists

My dad was in the hospital for 18 days until his release to a nursing home Tuesday for physical therapy. At age 99, he was fighting pneumonia and its aftereffects.

During that time my family experienced a relatively new breed of physicians called hospitalists. Until the 1990s, hospitalized patients were visited by their own doctors. Under the hospitalist system, inpatients see physicians who practice only in hospitals. Most of the physicians are board certified in internal medicine — they’re the ones with the hospitalists title — but there are also specialists. Nowadays, nearly every hospital in the United States has adopted the system.

In theory, the system has advantages. Being on site all day, a hospitalist is more available than a clinic physician to meet with family members, follow up on tests, and coordinate the patient’s care from nurses and medical specialists. Clinic physicians don’t have to divide their time between the office and the hospital.

A drawback is that people don’t see their own physicians, who know their medical histories, when they may be at their sickest. My dad had a multitude of doctors to whom he needed introduction. His overbed table held a collection of business cards left by hospitalists, pulmonologists, cardiologists, a palliative physician, a nephrologist, and a urologist. Each would come in from time to time to offer an assessment. Their scheduled shifts determined whom we’d see on any particular day. They put notes into the computer to update the team. A critic of the hospitalist system, Dr. Michael Weinberg, wrote in a blog that “doctors [are] working designated shifts and moving in and out of patients' lives like clouds floating across the sky.”

In our experience, the system’s vaunted coordination fell short. My dad didn’t realize that the hospitalist (or rather the hospitalists, since there were three of them) was the main point of contact, and my siblings and I weren’t sure who was the main decider. Last Saturday and Sunday a pulmonologist and a cardiologist disagreed about what was causing Dad’s oxygenation problems — a scary situation, since he was struggling to breathe and the remedies were failing. It took until Sunday night for the two specialists and the hospitalist to get on the same page and determine a new course of medication. On Monday morning, another pulmonologist decided not to implement one of their decisions, and she also disagreed with that day’s hospitalist about when to release Dad.

Maybe dueling physicians produce better results than the previous MD-as-god model. Never having been an inpatient, I can’t judge which system I’d prefer if I were in the hospital bed. The argument that doctors could not provide enough care and attention to hospitalized patients when they had to hurry back to their clinics makes sense. A change was likely needed. Based on our experience, however, it still needs refinement.

*****

Life is full of irony. My dad was always the healthy one. I thought that he would outlive my mother, even though she is seven years younger. Not long ago I told a friend about the 100th birthday party we’re planning for next July and commented that I didn’t see any reason Dad wouldn’t make it to the century mark.

How quickly things can turn. How dangerous complications from pneumonia are to the elderly. Sunday the doctors told us that if their one last treatment didn’t work, we’d be discussing hospice. Luckily, the treatment has worked, but that doesn’t mean that Dad is out of the woods. A week ago he was doing well and ready to go into rehab, and then he relapsed.

For many years, as I’ve watched my friends cope with parents’ illnesses and deaths, I’ve said that my turn will come. It came with a bang in July and has continued since. First my mother fell and broke three bones, had surgery, was hospitalized, and spent 23 days in a nursing home for rehab. On her doctor’s orders, we moved our parents into assisted living. We cleaned out and sold their home. Just as things were settling down, Dad was diagnosed with pneumonia and went into the hospital for a prolonged stay. Now he's in a nursing home indefinitely.

All of that in less than five months. To say it's been grueling is not to be self-pitying but to recognize that none of us escapes our turn. Dad’s longevity and good health just lulled us into thinking we might.

*****

ANTI-TRUMP QUOTATIONS: 88TH IN AN ONGOING SERIES

“Donald Trump doesn’t clean up corruption anywhere. He lives and breathes it every day, in every way.”
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  • Business cards for patients? That's just foul! What about the people who don't have family members with them and don't know who's just walked in to do something personal? Thank you for this alert.

  • That's a good point about people alone and not realizing what's going on.

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