I have been in medical practice for many years and I did practice medicine when the family practice physicians did go and see patients in hospitals. Then the HMO insurances under misguided thought process decided that 'employing' some physicians who do not have office practice and do only hospital practice can 'save money' -the sole goal of Insurance company. I still remember that the family doctors complained about this and then the insurance company decided to 'allow' these physicians to see patients while they were in hospitals , but they will mot be paid. Now you tell me who would see the patients manage and take risk and not get paid . So they stopped seeing their own known patients in hospitals a nd thet lead to crop of new group of physicians called hospitalist. This is suppose to help health care. In my view they have added NO BETTER CARE and have increased EXPENSE. But I am not writing this blog for my view but want to tell about everyday problems that people like me face as consultant. So let me give stories of 2 different patients.
I have known this patient for long time and he had sleep apneas and I used to see him every 6 months . When he came to me last time, I was talking to him and realized that he had diverticular abscess - collection of pus due to infection in colon . He had no lung issues and I admitted him and did work up and got him started on treatment and drained abscess and he was seen by people that could manage this condition- surgeon, infection specialist. He was discharged and I did not want to see him as his problem was not related to my specialty .By the way he had seen gastroenterologist before I had seen him and decided to hospitalize him.
I had forgotten about him and then the wife called me and wanted to know if I was out of town as I did not see him. I called her and found out that after the discharge , he was OK and then in 3 weeks he had seen infection specialist and he did new CT scan of belly and that showed clot in lungs and so he was admitted . So this time he had LUNG PROBLEM and he was admitted by hospitalist and I did not get notified or called to see him. He was discharged and the patient and the wife had lots of questions like why did he get it . how long the treatment and the time gap between his CT scan of abdomen and the then the hospitalization. I had no answer as I had not seen him and I had to check the hospital computer and with the modern day computer generated notes I had hard time getting the information . So I had spent time to get information that was very difficult to get and may not be 100% correct. The hospital doctor - THE HOSPITALIST are not seeing him and have no office and they can not be approached by this patient, so it becomes responsibility for people like me who have to reconstruct the story based on someone else notes. In this case it was not that difficult but in my other patient I have gotten 6 phone calls on 3 different days for the questions related to hospitlazation when I was not consulted .