Hospitalists

An 83 year old woman presents to the emergency room complaining of stomach pain. She is not very bright, but very sweet. She lives with her equally uneducated and mostly deaf husband. With the new system of "Hospitalists", her primary care doctor, who she has known for nearly 20 years, is not called. Instead she is admitted to the hospital under their "Hospitalist" system.

The consult a gastroenterologist who passes an endoscope down into her stomach and finds "non-specific" gastritis. They then pass a colonoscope and find nothing. In the emergency room her heart rate is noted to be in the mid 50s, so a cardiologist is called in. The cardiologist orders an echocardiogram, several electrocardiograms and can't find anything, so they discontinue the heart medicine she's been on for the past 20 years and order a new, expensive one.

After 4 days she is discharged home. Her care is considered "thorough". Her primary care doctor gets a copy of the discharge summary and asks her to come to his office and bring all of her medications with her, in a bag.

Going over her medications, he finds a huge bottle of Ibuprofen which she was taking for sore back and knees. Apparently the hospitalist was unaware of this. This is what likely caused the gastritis. In addition, in her bag of medications was her husband's heart medicine, which is known to slow the pulse. She did not know how it got in with her medications, but she admitted she had been taking them for some time.

So, a 4 day hospital stay, with 2 specialty consultations and nearly 8 thousand dollars was all due to 2 medication mix ups.

Could her primary care doctor have prevented this, had he been the admitting doctor?

The argument for hospitalists is that they can streamline hospital care. The experience so far is that they are making more opportunity for specialists to consult and do procedures.