One of the best blogs I have found about aging is the New Old Age blog in the New York Times, which recently had a post about hospitalists. Back in the day, if you went to the hospital, you let your primary care physician (PCP) know, and he or she would come see you, and oversee your care while you were in the hospital. Since the 1990s, hospitalists have taken over the care of most people in the hospital. Hospitalists are often employed directly by the hospital, or they are part of groups that contract with hospitals. This arrangement is nice for the doctor–no office expenses, regular hours, no on-call, but it may not be so good for the patients, or for Medicare.
As the blogger reports, there are some research studies that indicate that hospitalists are not always beneficial. First and foremost, there is a lack of continuity, because the hospitalist has likely never seen you before. The study also reported that hospitalists save money for hospitals, because patients are discharged sooner, but overall hospitalists cost Medicare money. Why? Because those patients who are discharged sooner are often discharged too soon, and end up back in the emergency room or hospital. The study also found that patients seen by hospitalists were more likely to be discharged to nursing homes, while patients seen by a PCP, who is familiar with the patients’ home and support situation might be more open to discharging the patient home.
The thing to take away from this is that we have to advocate for what is in the patient’s best interest, and provide as much information as possible to all health care providers. We can’t just assume that the doctor knows best, particularly if the doctor doesn’t know you at all.