We Need Hospitalists, ER Providers and Outpatient docs

An essay by Richard P. Holm, MD

For the last two years, as I have been wrestling with my own health problems, I have experienced superb care provided by emergency room (ER) docs, hospital docs, and (after I was sent home) outpatient care providers. This included my primary care internist in Brookings, my teleconferencing oncologist from Sioux Falls, and my surgeon from Rochester. I’ve experienced and benefited from the perspectives of several scopes of practice. There has been a great deal of change from the way we used to do it, and I think we have to embrace the change.
 
When moving to South Dakota in 1981, I was not surprised to learn that those of us in the “Brookings Clinic” shared call and the responsibility of the ER, took care of our own patients in the hospital and saw people in our outpatient clinic Monday through Friday. This was a lot of work, but it taught all of us to know and appreciate the constant changing face of medicine and gave physicians an “up-close-and-personal” relationship with our patients.
 
Then, over time, hospitals throughout the state started hiring docs who worked exclusively in the ER. In Brookings, that change made our home lives better, but we lost some of our ER talents in exchange. Next, maybe 15 years ago, we obtained the electronic Intensive care unit (e-ICU) which gives our ICU patients the advantage of the extra eyes of a remote ICU specialist, allowing sicker people to stay in rural hospitals. However, the biggest change in the last few years involves how those patients admitted to hospitals are now being cared for by hospital care specialists (hospitalist).
 
Presently, when patients go home, there is a hand-off that must occur between the care of the hospitalist and the patient’s own primary care provider in the outpatient clinic. It is this hand-off which many believe could be better and is the center of an ongoing debate among doctors. I would advise patient and family to watch-dog this transition to make sure the hospitalist spoke with their outpatient care provider.
 
Scientific evidence-based studies have shown that the best overall care happens when it starts with an established outpatient primary care relationship. The best (and least expensive) health care would happen in this country if EVERYONE had a designated primary care provider who would hand-off and receive from the hospital team when necessary.
 
Change is happening, and the benefits far outweigh the risks if only each of us could find and establish a relationship with a primary care provider.