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Thursday, December 29, 2011

Being a hospitalist and watching our hospital get digital

Since quitting my primary care job 2 months ago I have been working at our local hospital as a "hospitalist". I take 24 hour shifts, several in a row, and during those shifts I am responsible for taking care of all of the patients admitted to the hospital whose doctors can't care for them in that setting. This ends up with me being a consultant for some patients who are particularly complex and time consuming and being the primary doctor for patients whose doctors don't have hospital privileges or are out of town or who don't have a doctor at all. I meet lots of interesting people and get to know them and do the diagnosing, communicating and treating that they need until I go off duty. For many of these people I miss being able to see the whole illness through, like I used to do. It is freeing, though, to know that my responsibility ends at a certain time.

My days vary from extremely busy, where I can't even answer a phone call from my family and have to keep multiple juggling balls in the air all the time, to relaxing, where I can talk to nurses about their vacations and pester the ultrasound technicians to show me how to do imaging. I can sometimes leave the hospital during the day if I need to do something, and sometimes I can barely find a moment to jam some food in my mouth, and don't get to sleep much at night. Our hospitalist program is just getting going and we are working on making processes in the hospital fit us. We are trying to standardize our documentation (admission and progress notes) and still are pretty haphazard with regard to knowing exactly what and how to bill. We are a small hospital so we have only one hospitalist working at any given time, and we rotate shifts according to the demands of our lives and the availability of other doctors to fill in. We fill extra spots with doctors in the area who do this sort of thing and doctors from further away who we get through a physician recruiter.

Many small hospitals just hire a group that provides hospital services to do the whole program, hiring physicians, standardizing signouts, billing and that sort of thing. This is expensive, since the hospital pays heavily for the administrative services as well as the doctors. If a doctor doesn't work out (and in our experience, that does happen) there may be some conflict between the hospital and the hospitalist company. It's very much like the difference between hiring a babysitter oneself vs using an agency. I am glad our hospital is doing it our own way since it allows us to figure out what works best for us and keeps the lines of communication simpler. If we can't fill our spots, though, I bet the hospital administration will get desperate and hire a company.

Next month I will be working at a hospital a few hundred miles away which is larger than ours and which gets its hospitalists from a large hospitalist company. I will get a chance to see how a big operation does this stuff, which may help our organization stay independent. I will plan to continue to work at least some shifts at our hospital which will help me share what I learn. I will be working 12 hours a day for 7 days and then will have a week at home to recover. I'll be doing lots of driving.

Tomorrow is the last day of a block of 4 shifts that I have worked. It has been really busy. I think that everyone waited until Christmas was over to get sick and come in to the hospital because I've hardly had time to breathe. I have met lots of great people though. What has made work in December particularly challenging has been the fact that our hospital just adopted a computer system to handle nursing, ordering, lab and x-ray data. We had been inching along in that direction, but finally jumped into the deep end and now we have no lack of annoying hassles to commiserate about. The system comes from the McKesson company and is called Paragon. Superusers have been working on this for much of a year trying to write the program so it will fit us, but like all electronic medical records, it is full of weird little bugs, crashes, lags and unexplained inability to access what we need at inopportune moments. Some people are slower than others and we have had support staff resign over frustrations with it already. But having watched what happened when my outpatient office went digital, this is not as ugly.

I look forward to 2012, especially sleeping late on Monday and turning off my cell phone, however briefly.

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