The Doctor Is In: The Importance of Hospitalists
A Patient’s Unexpected Illness Reveals the Value of Onsite Hospitalists
On a cold night in January, the emergency room was the last place Laura Akins expected—or wanted—to be. A Deerfield native living in Buffalo Grove with her husband Matthew, she was still recovering from a recent caesarian section, and breastfeeding her newborn son Jonah. She had another son, three-year-old Kyle, and a busy career as an information technology consultant waiting for her after maternity leave.
Despite these demands, she was about to learn that she would need surgery, again. Fortunately, the new hospitalist program of Northwestern Lake Forest Hospital (NLFH) helped minimize the difficulties of an unexpectedly rough period for this busy mom.
A Hidden Problem
Akins’ son Jonah was delivered in January at Prentice Women’s Hospital in Chicago, at Northwestern Memorial Hospital. He was in the posterior position, meaning that his head was turned upward, a condition that involves a higher risk birth, increased back pain and potential complications for the mother. Akins' obstetrician/gynecologist (OB/GYN) decided a caesarean was best. Four days later, Akins was ready to go home.
But one of her symptoms from pregnancy—what she thought was painful gas, radiating around her back and stomach—continued to persist. Over-the-counter drugs that had worked during pregnancy were failing her, and at 3:00 am on February 10 she found herself unable to cope with the pain and discomfort. She planned to make an appointment with her OB/GYN as soon as possible.
“I called the doctor’s office first thing in the morning, and Matthew stayed home from work,“ Akins says. “I asked whether I should go to the ER in Lake Forest and the on-call nurse agreed. I was so glad that we had a close option and could stay in the same system, I’m sort of fussy about hospitals, and I knew that Lake Forest was now affiliated with Northwestern Memorial Hospital.”
What is a Hospitalist?
What she did not know was that one benefit of the affiliation with Northwestern Memorial Hospital (NMH) was that their new hospital medicine program was expanded to Northwestern Lake Forest Hospital. Now, three of Northwestern Memorial’s hospitalists are on staff 24/7 in Lake Forest. At any given moment, an experienced, board-certified physician is onsite to assist inpatients.
Hospitalists are physicians, board-certified in internal medicine, who do not have an outside private practice. Instead they choose to manage the care of hospital inpatients, including those in the intensive care unit. Hospitalists have a host of responsibilities ranging from daily patient monitoring and ordering tests and procedures, to following up on treatment and coordinating care between the hospital, primary care physicians and specialists. Hospitalists also consult with patients and other physicians before and after surgery.
According to Mark Williams, MD, Professor and Chief of Hospital Medicine at Northwestern University Feinberg School of Medicine: “Hospitalists can optimize patient care and tend to a greater number of patients with increasing continuity.”
Healthcare’s Fastest-Growing Specialty
Hospital medicine is one of the fastest-growing specialties in the history of American medicine, and yet not all institutions have these physicians on their hospital staff. At some hospitals, it is not uncommon to experience minimal daily contact with a physician, or to wait for decisions and results from the offsite physician or specialist. It also means fragmented, longer hospital stays and confusion for the patient. That is why quality hospitals are moving toward adopting a hospitalist standard—particularly academic medical centers like NMH and the hospitals affiliated with them.
A Chicago Tribune column recently discussed the increasing use of hospitalists, stating that it is “impossible for primary care doctors to be available to their hospitalized patients all of the time. Because they often aren’t on hand when problems crop up, emergencies may have to be dealt with over the telephone or handled by doctors-in-training who staff the hospital.” (Valerie Ulene. “Hospitals may not be for all doctors.” Chicago Tribune. February 1, 2010. chicagotribune.com/health)
“Busy private practices and other system challenges can affect quality of care, so there has been a national push for hospital medicine because of the emphasis on quality improvement,” says Gaurav Chaturvedi, MD, head of the hospitalist team at Northwestern Lake Forest. “A hospitalist can go in and act—the immediacy is there. And it has been shown to improve hospital stays.”
Reassurance in the Emergency Department
For Akins, who met Dr. Chaturvedi in the Emergency Department (ED) after emergency physicians had diagnosed the problem, it meant finding reassurance and answers to her questions right away:
“When we walked into the ED, I had a newborn in my arms and had no idea what was wrong with me. I soon learned that my gallbladder would have to come out—my second surgery in less than three weeks. I was near tears and overwhelmed with questions: what kind of surgery is this? I was still on meds from the C-section—would someone call my doctor? What about the breastfeeding? My mind was swirling with all of the things I needed to do for my kids and how the new surgery would affect that.”
Akins recalls that Dr. Chaturvedi met with her and Matt, carefully answered all of their questions and explained why the surgery was their best option: “I was surprised by the personal attention. Dr. Chaturvedi could empathize, and it made me feel a little better.”
For Dr. Chaturvedi, it is all about patient advocacy: “I establish a rapport and try to show patients—and their physicians—that they can trust us to oversee the care.”
Crossing the T's, Dotting the I's
Kim Sobinsky, MD, a surgeon at NLFH for 24 years, removed Laura’s gallbladder the following afternoon. Dr. Chaturvedi attended to her during her stay. However, much of Akins’ care happened behind the scenes: monitoring her progress, calling her physicians at Northwestern Memorial Hospital, arranging for follow-up care and even communicating with family members. Dr. Chaturvedi describes himself as a “point person”: patients always have a physician who is there crossing the T's and dotting the I's and moving their care forward. Things work according to their convenience—not when their doctor is available.”
“It’s definitely a good thing,” Akins says. “Hospitalists are not something I was familiar with before, but now I can understand the importance of having someone in that role.”
Back to Normal, At Last
Akins is home now and feeling good despite her nearly back-to-back surgeries. On a large dining room table nearly covered with toys and snacks, her laptop is up and running. This self-described workaholic is glad that the continuity of care at Northwestern Lake Forest Hospital helped her get back to where she could focus on her sons—and even start catching up on some work.
“I realize now that my gallstones were developing all along, perhaps masked by my pregnancy symptoms,” she says. “The Lake Forest ER doctors uncovered the underlying problem, and the hospitalist calmed me down, laid out my options and talked to me in a way that we could understand.”
Does Your Hospital Offer Hospitalist Care?
Not all institutions have hospitalists, physicians attending to inpatients onsite, 24/7. The benefits of hospital medicine at NLFH include:
- A board-certified physician onsite at the hospital, 24/7, keeping a close eye on you
- Expertise in internal medicine and other areas such as gastroenterology or hematology
- Immediate action: ordering tests and procedures, follow-up on test results, adjustment to treatment plans
- Close coordination and consultation with your primary care physician and specialists
- Someone to address your family’s questions and concerns