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PCPs have lost quarterback position on hospital patients’ teams


Stephen C. Schimpff, M.D., writes in Medical Economics:

There is a crisis in primary care and it’s now flowing over into the hospital when a primary care physician’s (PCP) patient is admitted.

 “No longer cared for by the PCP, the role has largely fallen to the hospitalist. There has been a loss of the long time primary care physician-patient relationship and the trust that comes with time. There has been a frequent loss of satisfactory communication when the patient is admitted and again when discharged. At a time when the patient most wants and needs the comfort of a long-time trusted professional friend, the patient instead is confronted with a stranger at the helm. What has happened to create this state of affairs?”

To read all of his remarks, please hit this link.

Reduce the number of medical cooks



“A Kitchen Interior” (c. 1565), by Marten van Cleve.

Suneel Dhand, M.D., an internist,  says medicine is suffering from “Too Many Cooks in the Kitchen Syndrome”.
The scenario goes like this.”A patient is admitted to hospital and due to the complexity of their illness, they will end up seeing a number of different specialists. In the old days, their primary care doctor would still be seeing them in the hospital. Now however, they are typically assigned to an internal medicine doctor, known as a ‘hospitalist.’

“The problem is that this hospitalist usually hasn’t met them before, so has to start from scratch. Depending on the case, other specialists involved in their care may also include surgeons, cardiologists, pulmonologists, nephrologists, gastroenterologists — you name it! But due to the busy environment of a hospital, there will often be very little direct communication between these different doctors.”

This is “emblematic of a much bigger problem — namely, the fragmentation of the healthcare system. It negatively affects patient satisfaction and the hospital experience, causing a lot of frustration and miscommunication along the way.”

“So what’s the solution? Well, the start would be to make it absolutely crystal clear who the “captain of the ship” is during the hospitalization. This will usually be the hospital physician (for a medical patient). The next step is to ensure that every specialist who sees the patient understands who this primary doctor is (and also re-emphasizes that to the patient), and communicates their plan immediately to them.”

“The next thing is to get the hospital physicians on board themselves to take on the mantle of “captain of the ship” — even if care is mainly being directed by another specialist (e.g., a patient awaiting a surgical procedure). Furthermore, these physicians need to have adequate time to take on this role, so it’s critical that they shouldn’t be overwhelmed themselves with excessive workloads.”


Hospitalist supervising residents overnight didn’t raise outcomes


In recent years, many teaching hospitals have established  overnight  hospitalist programs. In these,  hospitalist physicians supervise overnight medical residents with the idea that this would improve quality of care and boost safety.

But, Fiercehealthcare reports,  a recent study found that in one such program, at the Penn State Hershey Medical Center, “having an on-site, attending-level physician provide overnight supervision did not make a difference in quality of care. The medical center did not see any significant impact on important clinical outcomes, according to study results published in the Journal of General Internal Medicine.”

However, it should be noted, “the research looked at only one model of an overnight hospitalist program at one hospital and more study is needed into the pros and cons of such programs,” Fierce reported.


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