ABOUT HOSPITAL MEDICINE

Medically speaking, we came of age when physicians cared for their patients in the office and the hospital. We admitted them, saw them once or twice a year, and assisted with their surgeries. So when we decided to work directly for our patients rather than for the insurance companies, we had to consider what to do about hospital care.

We liked being in the hospital: It allowed us to maintain a subset of our skills and work shoulder-to-shoulder with other physicians from whom we learned and who we taught. But ultimately, we decided it would be better if we stuck to office medicine. Here’s why.

First, we don’t like waiting when we’ve made an appointment, and we know nobody else does either. So, we made running our office on time a high priority. Hospital medicine throws a major monkey wrench into that, because when the hospital calls, one has to stop what one is doing — even in the middle of an office visit — to respond. And when an emergency arises in the hospital, your physician has to attend to it — even if that means driving there. Patients are usually understanding, but even the sickest patient spends just a small part of their year in the hospital. Wouldn’t it be better to be available when and where our patients need us for 99-100% of their medical care in a given year? 

Around this time, hospital care became a medical specialty. Hospitalists are, by definition, in the hospital, so they are on-site when patients or their nurses have questions or when emergencies arise. And when important decisions are made by specialists, a hospitalist is there to weigh in on and influence those decisions. 

Physicians everywhere, whether working in a small rural hospital or a large medical center, usually believe their hospital provides their community’s best care for all conditions.  But is that true? We don’t think so. We believe our patients are best served when we broaden our horizons and choose hospitals exclusively based on the quality of the care they provide for a particular medical or surgical issue. For example, we tend to use one hospital for neurosurgery and another for cardiovascular operations.

Of course, this means we devote a lot of time to meeting and evaluating the physicians (and psychologists, physical therapists, dietitians, etc.). But it ensures that when we make a referral it’s to someone we would use for ourselves and our families.

We’re blessed with an excellent medical community here in Colorado, but occasionally, problems arise that need ultra-specialized care that isn’t available locally. That’s when we go national: We’ve used the Cleveland Clinic, the Mayo Clinic, MD Anderson, Sloan-Kettering, and University of California San Francisco, to name a few.

The truth is, we don’t know everyone at each of those medical centers. But we know how to find expert clinicians. We do this by asking our local specialists, conducting online research, and reading studies published in major medical journals. Once we’ve homed in on physician experts, we often reach out to them directly, something that’s been made easier these days by the medical journals, which now routinely publish authors’ email addresses.

So, what’s it like when our patients need to be hospitalized? They typically call — remember, we answer the phone live 24/7 — and we decide which hospital to use. We call the Emergency Department to let the staff know our patient is coming and to confirm the fax or email number. Then, we send our patient’s detailed medical history — a concise document that describes all their medical issues, medications, allergies, surgeries, etc. — and remind them we want to be kept in the loop. Once a diagnosis has been reached we review the results and participate in planning the next steps. And, if surgery is needed, we have a discussion about the best-qualified person to perform it. 

By the way, this is exactly what we do when our patients are out of town and have a medical emergency.

We know that there are some concierge doctors who do hospital work. We understand the attraction, especially since most concierge physicians are affiliated with one or two hospitals. It’s certainly convenient for them, and if their office is on a hospital campus, they are often expected to refer patients there. 

This begs the question: Do they really think their hospital has all the best specialists in our region? We continue to believe that careful analysis of the strengths and weaknesses of all of the hospital options serves our patients better than a one-size-fits-all approach. 

In short, we cherry-pick the best for our patients this way because we believe it’s simply better medicine.

 


The information posted on this blog and website are for general information only and should never be relied on as specific medical advice for an individual reader.  No financial relationship exists between us and any recommended products or persons mentioned. All material contained here is the property of the Sheldon Sowell Center for Health, PC, and cannot be copied, reprinted, or linked to without our express permission.

Phone: 303-789-4949
Fax: 303-789-7495
1780 South Bellaire Street #700
Denver, CO 80222