The hero case managers

As someone who has practiced hospital medicine up and down the East Coast for the last several years, I've had the fortune of working with some absolutely terrific colleagues. The hospital environment is by its very nature a busy and hectic 1—where we all put our heads down and work tirelessly at the coalface for hours on end. Doctors are among the most hard-working professionals out there, often practicing our skills under extreme time pressure in life or death situations. But I'm not going to write here about how hard myself or my peers work, because we already know that (or should do). Not so long ago, I wrote a piece about nurses being the Superstars of Healthcare. The article received a lot of positive responses, which I was glad about. Think hospitals, and the first frontline professionals that usually come to mind for the general public are doctors and nurses. But I'd like to write here about my appreciation for another group of dedicated professionals: case managers, and the great and important work they do every day all across the nation.

Hospital physicians know that the case manager is the go-to person any time we are discharging a patient, especially if they need home services or are entering a rehabilitation facility. But having worked closely with some outstanding case managers, I believe that the work they do to discharge our patients and keep the hospital door revolving, is not always fully appreciated by all those around them.

Typically case managers are qualified nurses, which gives them a solid clinical background. Before a physician has even seen their patient, the case manager will have often “screened” them to help work out what they may need upon discharge. They will usually initiate communication with families, and by the time the doctor has seen the patient for the first time, it's not uncommon for the case manager to actually know more about the patient than the MD!

I've seen first-hand the mountain of paper and computer work that is required to discharge any patient. The dozens of phone calls, emails and pages to doctors. It's a very tough job. To compound this over the last few years, case managers are now intimately involved in determining whether a patient's admission status is appropriate and discussing this with the physician (i.e. observation versus inpatient). Anyone in health care right now knows that this is an often crazy and frustrating maze to navigate. Add to the mix the general push to discharge all patients as soon as possible, their workload is becoming exponentially more difficult with these increasing pressures and asks.

Without the case manager, the job of any hospital physician is impossible. So whether you next speak with them at random times during the day, or at organized multidisciplinary rounds, take a moment to appreciate the awesome work that they do to keep our patients moving.

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.