Health column: What is a hospitalist?

Last Modified: Thursday, September 26, 2013 at 3:22 p.m.

Q. What is a hospitalist?

A. The simple answer is (for most patients): the doctor who will take care of you while you're in the hospital.

A more detailed definition, from the Society for Hospital Medicine, is: Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine.

Q. Why are there hospitalists?

A. Just as most physicians have given up the practice of house calls, most outpatient "primary care" doctors (the doctor you see for your general health care, such as family medicine doctors, internal medicine doctors, and pediatricians) are giving up visits to the hospital as well. There are many driving factors behind this trend: increased time pressures, the higher complexity of patients in the hospital compared to 10 or 20 years ago; the need to see more patients in the office, and the physician's need to balance their work and home life.

In addition, people are just living longer — and unfortunately, "aging gracefully" is not something we can all expect. With longer human life spans come increased potential for each person to accumulate various medical issues and complications. It has become increasingly complex for physicians to both manage their patients in the hospital and meet the demands of patient care in their regular outpatient practice. Inpatient work demands staying up with rapidly changing technology and juggling the work of multiple consultants; it is a now a full-time job.

Q. What it's like being a hospitalist?

A. I belong to the Asheville Hospitalist group, which is a group of internal medicine physicians based out of Mission Hospital. We spend most of our time caring for patients. Many of us also take on other hospital-based responsibilities, such as quality improvement, research, information technology, geriatrics, palliative care, teaching medical students and residents, and patient safety.

An average day for a hospitalist involves caring for patients with a wide array of illnesses, such as liver failure, a heart infection, newly diagnosed cancer, stroke, alcohol withdrawal, emphysema, or an irregular heartbeat. Issues can be as simple as a gallstone or as complicated as discussing end of life care. Many of our patients have 5 or 6 major problems, and might be on over 20 medications. I may call a kidney specialist, cardiologist, psychiatrist and neurologist to weigh in on complex cases. We collaborate with care coordination, physical therapy, holistic nursing, nutrition, occupational therapy, respiratory therapy, and social work on most of our cases. One family I took care of recently said, "Thanks for being our quarterback."

How to work with a hospitalist physician:

If you find yourself in the hospital, or if a loved one is hospitalized, you may very well find yourself interacting with a hospitalist. Here are three tips for working effectively with your hospitalist:

1. As a family, select one person to be the main point of contact, and if you can't be there for the hospitalist visit, please leave a phone number on the white board in the room just in case.

2. We see patients all day, so please let us know if a certain time of day works for your family, we will do our best to accommodate that. It is important for us that families are present and involved!

3. Hospital stays are a very good time to consider long-range planning for health care, such as who you might want to be your Health Care Power of Attorney, code status or feeding tubes. The hospitalist is a great person to ask about these sometimes difficult decisions.

Why I became a hospitalist:

I thought I would go into primary care out of residency: my goal was to take care of people, to get to know them, to make them healthier — that is why I went to medical school. The role that helped me balance those interests with the rest of my life, including raising three boys and volunteering overseas, turned out to be that of hospitalist. I feel it is a privilege to care for people in crisis: hospital admissions are often life-changing events, many times unexpected, and sometimes even traumatic — and frequently an event that patients and their families are not expecting. As a hospitalist, I find myself serving as an integral part of this experience, working both as a team member and as a liaison to a family — delivering wonderful news, and the worst possible news. It is exhausting at times, but also incredibly rewarding, and above all, never dull.

Dr. Samantha Read-Smith is a hospitalist physician at Mission Hospital in Asheville and serves on the board of the Western Carolina Medical Society Association.


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