Inpatient physicians, one of the fastest growing medical specialties, can now be found in American hospitals. These doctors only provide in-hospital care and are known as "hospitalists."

Upon admittance to a hospital, a patient is introduced to a hospitalist who will supervise his or her care for the duration of the hospital stay. (Attending physicians are often, but not always, hospitalists) Not only does this physician treat the condition that caused the patient to be hospitalized, but he or she will also supervise care of any other medical conditions.

Two leaders in the field, Navneet Kathuria, MD, and Brian A. Markoff, MD, oversee the adult inpatient care at the Mount Sinai Medical Center in New York City. They described some of the benefits of this specialty.

Primary care doctors spend many hours seeing patients in their offices and have a limited amount of time to make hospital rounds. Knowing that there is a doctor on site supervising care, reviewing all tests and evaluating the patient's progress throughout the day reduces the burden on the primary care physician and reassures the doctor and the patient. In the past, the doctors were also supervising from their offices via telephone calls with the nurses and residents. Now, there is often 24-hour-a-day coverage with hospitalists.

Who The Hospitalists Are

The majority of hospitalists specialize in general internal medicine, although some are specialists in pulmonary and critical care medicine, cardiology or other subspecialties. A number of nurse practitioners and physician assistants also specialize in providing inpatient care. Additionally, there are pediatricians who work with hospitalized children.

At Dr. Kathuria's hospital, a hospitalist will supervise approximately 15 patients at a time who are almost always medical-not surgical-patients. However, in some hospitals, this too has begun to evolve-particularly in orthopedic surgery patients. With joint replacement on the rise for older people, more patients with other conditions that require monitoring are admitted. With a team approach, the orthopedist performs the surgery and the hospitalist monitors the medical aspects of the patient's needs in order to prevent complications—including chronic conditions, such as diabetes. With diabetes, for example, it is critical to keep blood sugar levels under control for the patient's health, and it's also very important for proper healing after surgery.

Effective communication is the cornerstone of hospitalists' work, whether with the patient, the primary-care physician or the other doctors involved in the patient's care. The hospitalists who are assigned patients at the time of admission gather background information from the primary care doctor upon admittance to the hospital and keep the primary care physician apprised of the patient's condition on a regular basis. While care may vary from hospital to hospital, you can expect your hospitalist to see you every day, and sometimes twice a day-often with an in-depth visit every morning and another visit late in the day.

The hospitalist also stops by any time there are tests to review or complications to deal with. (Generally, primary-care doctors can see the patient who has been hospitalized as well, but this can't replace the on-site, moment-to-moment care that hospitalists are able to provide) The hospitalist also works closely with the patient at discharge.

The hospitalist gives the primary-care physician a written or verbal summary covering not only what happened during the hospitalization but also what the patient needs to do to continue care at home, including prescriptions and medical follow-up. The patients often get a copy of this discharge summary.

What Patients Should Do

Dr. Kathuria and Dr. Markoff believe that there are several ways in which patients can maximize their experience with a hospitalist, stressing the vital importance of communication. They sug. gest having a general conversation with your primary-care doctor to learn who would be involved in your care if hospitalized. Will it be just your own doctor or will a hospitalist be assigned to you? While it's always good to be under your own doctor's care, the hospitalist is far more available to you while in the hospital. Depending on your potential needs, you may want to select a hospital specifically because it has hospitalists on staff and then work with your doctor to learn who would be assigned to your case.

Find out from your own doctor how you can best stay in touch with him/her during this time and how your doctor will be communicating with the hospitalist to ensure the hospitalist has all your pertinent background information... and that your primary care physician will have all information once you are released. When in the hospital, it is absolutely key to get the name of the hospitalist(s) who supervised your care and all contact information for reaching this person later if necessary.

Having a designated hospitalist work on your case in the hospital is one way to potentially reduce the risks and help improve quality and continuity of care. And, in general, hospitalists reduce costs by providing efficient care and reducing the length of stay in the hospital.

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