Blog | Friday, July 29, 2011

Subspecialist offers olive branch to hospitalists


Today I would like to say thanks to a group of colleagues that too often go un-thanked.

These would be my hospital-based internal medicine friends: hospitalists are what they are called.

This idea came to me after reading Dr Robert Centor's post on KevinMD. (For the record, Dr. Centor is one of my favorite physician-masters-of-the-obvious. He writes frequently on his blog, db's Medical Rants.) In his usual concise manner, he laments the lack of respect that many sub-specialists show hospitalists.

I feel differently about my hard-working colleagues.

As a sub, sub-specialist who works primarily in the hospital, I would like to say how grateful I am to have knowledgeable, hospital-based internists available.

I believe, and write frequently about the importance of seeing the forest through the trees. A good doctor must see the big picture: a little atrial fib, for instance, isn't a major problem if you can't move, eat or have widespread cancer.

But for good patient care, the details are important too. Hospitalists are good at details. In fact, an internists' area of expertise is in using, considering and synthesizing such specifics. They mesh together a patient's history, exam, laboratory values, X-rays, and other specialists' opinions. I feel strongly that having thinkers on the case is a good thing.

What's more, as the technology of medicine expands, the sub-specialists' scope of expertise grows even more narrow. This fact only increases the value of internists.

Take this humorous story as an example of such narrowness of scope:

A nurse and I were chatting outside a patient's room in the intensive care unit. A day or so before, I had implanted a pacemaker. We overheard the patient and his wife arguing about whether I could write him a prescription for his blood pressure medicine. The patient said, "Doctor Mandrola can write me a prescription for this medicine." The wife countered, "No he can't. He isn't a real doctor; he's just the guy who put in your pacemaker." From that day on, this nurse reminds me that I am just an installer, or these days, an ablator. Barely a real doctor.

As one who hangs a lot of self-esteem on how well my patients do, I am grateful to have recently-trained, detailed oriented, conscientious hospitalists around to help me, help my patients.

And I do not begrudge them for finding a job that pays well, and ends at the end of the shift. Good on you; you are probably less likely to get AF.

Thanks, all you hospitalists!

This post by John Mandrola, MD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.