Essay: Hospitalist system is a change for the better

The role of primary care physicians (family doctors and internists) at Martha’s Vineyard Hospital is going through a big change. Primary care doctors will no longer treat patients while they are admitted to the hospital. Adult patients who are admitted to the hospital will be cared for by internists whose job is to care for hospitalized patients. These doctors, who are called hospitalists, do not have office practices. They are on the hospital floors throughout the day, from 7 am until 7 pm, seeing all of the admitted patients, and they will be on call to the hospital during the night. Your primary care doctor will therefore work only in his or her office.

This system in which patients have different doctors for hospital care than for office care started about 15 years ago and is now a usual practice across the United States. Martha’s Vineyard Hospital is one of the last hospitals in New England to adopt this system.

Nonetheless this is new both for Martha’s Vineyard patients who have always known that their doctor will be responsible for their care in the hospital, as well as for the doctors who expected to care for their patients if hospitalized.

Let me say that this is mostly a good change, and with the transformation that is taking place in medicine there is really no choice. Hospital medicine is in many ways different than office-based medicine, and it is a field that is changing rapidly with new tests, new medications, and new ways of caring for many diseases and conditions. Hospitalists have received special training for this kind of medicine, and because they do it every day they are able to keep up with new developments. They are on the floor all day long and therefore more available to patients and their families. They will usually have more time, and are not held to an office schedule with certain times available to go to the hospital, usually at the beginning and end of the day. Family meetings can take place at any time. Coordination of care among different professionals is easier, and transfers to larger hospitals if necessary are more easily arranged.

Patients understandably will say, “but my own doctor knows me better,” which is true. However, the hospitalist and the primary care doctor will coordinate the patient’s care together, and the primary care doctor can speak to the hospitalist to review special issues. Also as many patients realize, patient care in the past 20 years has become more complex, and each visit takes more time, more paperwork, and now more computer work. This is true in the hospital and in the office. A primary care doctor can no longer “do it all” and “do it well.” Although the system will be different, I have no doubt that patients admitted to Martha’s Vineyard Hospital will continue to receive high-quality care.

Dr. Henry Nieder practices family medicine at the Martha’s Vineyard Hospital.