Monday, July 15, 2013
What's in a hospitalist's name?
I must confess that I love my job as a hospital medicine doctor. To me, very few specialties in medicine can be as rewarding as the one I've had the privilege of practicing for the last five years. We manage an array of medical illnesses, interact with staff from across the hospital in every different specialty, and follow our patients all the way through their hopefully very short hospitalization. We take ownership of our patients' complete care as the "captain of the ship." Specialists weigh in with their expert advice, but the buck stops with us. The close relationships we form with patients and their families, who entrust us with enormous responsibility, makes our job very unique and special.
As a physician trained in internal medicine, I'm sure I would have enjoyed primary care just as much. My experience of outpatient clinic during my residency was overwhelmingly positive. Nevertheless, I consider it lucky that I graduated at a time when the specialty of hospital medicine was really taking off. As fewer primary care physicians choose to round in the hospital, it can only be good for our patients to have their doctor present on the floors instead of rushing back and forth to the office.
Considering how entrenched our specialty has become, it seems amazing that the practice of hospital medicine in the United States only started gaining traction within the last decade. I have just returned from our biggest annual conference--this year held in National Harbor, close to Washington, D.C. The attendance was in the thousands, and I felt honored to be around so many leaders in our field. There is a palpable sense that healthcare reform will mean our scope and responsibilities are going to expand exponentially. We are uniquely placed to get a complete view of the American hospital system and gain insight into opportunities for enhanced inpatient care, quality improvement--and yes, cost savings. No other specialty can have such a frontline perspective.
Which brings me to my main point: What do we call ourselves within this ever-changing U.S. health care system, especially one where our roles and profile are going to increase?
The word "hospitalist" was first coined in 1996 when it was used in a New England Journal of Medicine article as a way of describing those internal medicine doctors who practiced inpatient medicine instead of primary care. Since then, the term has become commonly used within the hospital industry. From physicians, administrators, and those aggressive job recruiters, there seems to be a lot of demand for hospitalists.
But let me stop right there to make another confession. I have always found the word hospitalist more than a little ridiculous and in five years of being one, have never referred to myself as one. Neither, more importantly, have I ever introduced myself to any patients as such. I even avoid putting that title on my name badge. Before I get the hospitalist champions around the country leaping off their chairs in disbelief, and without sounding pompous in any way, let me explain my reasoning behind this.
I have found that the vast majority of patients are not familiar with the word and find it completely confusing whenever my colleagues have tried using it. This applies especially to elderly people who form the bulk of our daily census. I've even heard of some patients and relatives getting worked up because they believe it is something to do with "hospice" care! I'm sure my experiences are not unique. It's not a term widely used outside the medical industry, and I've yet to hear a major news outlet like CNN report on what a hospitalist is or isn't doing (unlike their frequent use of other specialist names like "cardiologist" or "pulmonologist"). Something tells me they will unlikely ever do so.
Does calling ourselves a name like hospitalist give us additional lobbying power? I believe we may be fooling ourselves with that argument. Many other countries simply call their general medicine inpatient doctors "Hospital Physicians" or "Medical Consultants" without any perceived loss of power or status. Could the problem be that we are just a new specialty that needs more time to be recognized? If hospital medicine leaders think that a hospitalist, who is essentially a general internist, will be seen one day with the same unique meaning and recognition as a "cardiologist" or "neurologist," I question whether that should even be the aim.
That is why in my five years of practice I have always introduced myself as the "hospital medicine doctor," the "attending internal medicine physician," or the "medical attending that will be taking care of you." I've had nobody question my specialty or what I am doing; it's obvious. When I know that lots of other specialists are going to be involved with my patient's care, I will add a sentence along the lines of: "I will be your main doctor who will be coordinating with all the other specialists too." One health care group I previously worked with even encouraged use of the term "hospital-based internist", which also seemed like an interesting idea.
I simply cannot believe that the word hospitalist enhances our specialty in any way. But I also wonder if the initial push by the hospital medicine community to use this new term represents a bigger problem we have in society. That is the overwhelming need to compartmentalize and package absolutely everything in life, often self-explanatory things that don't need any further packaging.
I grew up in England, where we also like to carefully classify all our occupations. When I first arrived in the United States almost a decade ago, I remember being shocked at how much further along this process is. It seems like we need to box everything to understand it, under the assumption that it can bring some additional prestige and acceptance. One amusing experience I had shortly after starting my residency was seeing the word "garbologist" printed over a local trash truck in Baltimore. Seriously? Not to equate a hospitalist with a garbologist, but the underlying thought process is surely similar. The same mentality of arriving at a name that doesn't necessarily need any naming!
Or perhaps this phenomenon is unique to medicine. After all, we are scientists at heart who like to form categories. Why don't other professions such as lawyers or engineers do this? Lawyers gladly introduce themselves as "corporate lawyers" or "real estate lawyers." engineers are "mechanical engineers" and "chemical engineers." I don't recall ever hearing any hybrid terms like "corpolawology" or "chemicoengineerist." What's going on with us doctors?
We belong to an ancient profession. The word doctor is over two thousand years old, aptly derived from the Latin doctus meaning "teach" or "instruct." Physician was used traditionally to describe a medical doctor, and King Henry VIII granted the first charter to form the Royal College of Physicians in 1518. In almost every country in the world, a medical doctor is considered to be the most noble and prestigious profession, the title only conferred after one of the most rigorous university courses in existence. It is a privilege and honor to be one. Why not be satisfied with being a doctor first and foremost, without confusing anyone? I've seen some of the best cardiologists I know introducing themselves as "heart doctors." Nephrologists introducing themselves as "kidney doctors." They are equally respected and understood, even though the terms "cardiologist" and "nephrologist" are much better known to the general public. We could even learn from emergency room doctors, who haven't felt the need to devise any additional specialty name.
So as for hospitalists, one of the newest specialties in American medicine, it may be a case of shutting the barn door after the horse has already bolted. If my colleagues are okay with referring to themselves as the hospitalist, then I don't seek to tell any of them to change their proclaimed title. But my own sense is that I'm not the only one who feels this way. That's why I'm happy to continue as the "medical attending," "internal medicine physician," or the "hospital medicine doctor." And most of all, I really hope, so too are my patients.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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