Explain Hospitalist Medicine To Me

What is a hospitalist?. Explain hospitalist medicine to me:

"A Hospitalist"  It used to happen everyday. This 5 word conversation.  Much less frequently these days. The public is getting used to us.  A hospitalist. That's me. That's how I make my living.  A reader, a med student, recently asked my to explain what I do. Possibly a hospitalist in training?

So here goes...  I am a a board certified internist (What is an internist?)who chose to practice the art of medicine in a hospital only setting. I have chosen to avoid, in my own eyes, the world of clinical internal medicine and all the issues that come with that.

I am in the eyes of my state an internist. I practice adult medicine. All encompassing. No Obstetrics. No kids. No surgery.  Everything else is free game. The large vast tundra of adult illness. And it is huge.  I start the day, everyday in morning conference. With my colleague hospitalists. The night rounder. We split up admissions in our own system to "round on".  We have multidisciplinary rounds with a social worker, pharmacist and our nurse coordinators.  Our nurse coordinators are invaluable. Speaking with families, floors, social workers, all through out the day.

On a daily basis I round from room to room spending on average about 1/2 hour per patient (even though you see me for much less, the behind the scenes time is at least double to triple). I review all data. Labs, xrays, EKGs, nursing records, physical therapy records, pharmacy recs, nutrition recs, specialist notes, orders and recommendations.

I am the central core of care in a fragmented system of hospital care.  I admit patients to all levels of care in the hospital, from observation to intensive care. My knowledge base is vast and capable.  I make decisions on what specialist, if any I need to help me care for my patient. I speak with families. I recommend further evaluation. And I recommended watchful waiting.

And often times I recommend hospice care. Comfort care.  I spend lots of time communicating with nurses, labs, specialists, technologists, radiologists. I hunt down information. I make things happen.  I do it efficiently and expeditiously. I don't accept that pathology won't be back until later. I don't accept that the xray report isn't transcribed.  I look at the xray myself. I call the radiologist. I make decisions on care.


I save time for the patient and hospital.  I save money for the patient and hospital.  I keep things moving.  I handle emergencies. Critical care stuff.  Code Blue cardiac resuscitation.  I do emergent cardioversion.  I can sedate.  I can intubate.  I place large IV's called central lines.  I manage ventilators, medications, interpret arterial and central venous pressure monitors, all the while multitasking and coordinating and communicating.  I am always talking with families, conferences with social workers, families, specialists.  I am the central core of care in a system of fragmentation. I bring order in a land of disorder.  I am the one that pushes my colleagues to keep moving, sometimes to their distress. But I keep moving.  I do the work of specialists. Often.  I manage heart failure.  Rhythm disturbances.  I manage sepsis.  I manage ventilators.  I treat pneumonia and emphysema.  I manage strokes.  I manage blood clots.  I know my limitations.  A doctor must know their limitations.

This is my job. Day in and day out. No day is ever the same.  I am a hospitalist and I love my job.  I see patients at the request of primary care. I see patients at the request of specialists, when their primary care doc approves.  We are a full service physician, available 24 hours aday, in person and at the bedside.  Always.  And when my shift is done, I turn it all off and go home where I enjoy my family.  Uninterrupted.

We provide a service where patients, families, primary care docs, specialists, hospitalists and myself win.  WIN-WIN-WIN-WIN-WIN  There are no losers in well run hospitalist programs.  A model of care with all winners.  This is how medical care should be.  All winners.  And this model is brought to you courtesy of relationships external to the LOSE-LOSE system of government run health care delivery called Medicare.

It is a telling tale of the power of WIN-WIN relationships. Great things happen when everyone wins.