WHILE IT DOESN’T happen often, it does happen: Patients—when they disagree with their pain management, treatment or discharge plan—want to dismiss their current hospitalist and be assigned to a different one. In the vast majority of such requests, doctors are able to address patients’ concerns and continue to provide their care. But in instances where communication can’t be repaired, some hospitals follow formal policies for how to allow patients to dismiss their current inpatient clinicians while others take a case-by-case approach. Regardless of whether hospitals have such a formal policy ..read more

WHILE IT DOESN’T happen often, patients do sometime ask to “fire” their hospitalists, says Naznin Jamal, MD: Patients—who disagree with their pain management, treatment or discharge plan—want to dismiss their current hospitalist and be assigned to a different one. “In the last 12 months, a colleague learned from a nurse that a patient and family wanted to ‘dismiss’ him,” says Dr. Jamal, hospitalist medical director at Jefferson Regional Medical Center in Pine Bluff, Ark. “But he was able to talk to them about their concerns, and the dismissal was then removed.” That’s the outcome for the vast ..read more

WHEN PATIENTS SOUND off (sometimes to the point of being rude) about wanting a different doctor—because they disagree with the treatment or discharge plan or pain regimen—many physicians feel comfortable sitting down with that patient and family and trying to get to the bottom of their concerns. That’s according to Ijeoma Carol Nwelue, MD, chief of hospital medicine at Baylor Scott & White All Saints Medical Center in Ft. Worth, Texas. But sometimes, Dr. Nwelue says, such a confrontation also entails a bit of education for the provider involved. “For some physicians, the instinct is to re ..read more

WHILE THE NUMBER of patients asking to be assigned to a different physician may be on the rise, so are the number of family members behaving badly. That trend has some hospitals creating policies outlining behavioral expectations. At Rochester Regional Health in Rochester, N.Y., Anil Job, MD, a hospitalist who now heads up the health system’s transfer command center, said that when family members become disruptive, he and his colleagues now rely on a written set of behavioral expectations. “It’s important to have healthy boundaries—and in our institution, we believe that we are allowed to set ..read more

WHAT WORKS TO CONVINCE patients to not “fire” their doctor in specific situations? Sources offer the following tips to prevent dismissals: • Pain management: “It often takes a bit of time but we work to educate the patient about why we are doing what we’re doing,” says Ijeoma Carol Nwelue, MD, chief of hospital medicine at Baylor Scott & White All Saints Medical Center in Ft. Worth, Texas. “If we feel there is room to adjust their dosing, we absolutely will do that. But we also set clear guidelines, saying things like ,’OK, at this point in your disease process, we would expect your requi ..read more

ARE YOUR PATIENTS recording you without your knowledge? And if so, how do you handle it? Chalk it up to the pandemic and the political-medical disagreements that it fostered, but Naznin Jamal, MD, now feels that “the atmosphere has become a bit more hostile to medical staff in general. I believe that’s more true for nurses, they bear the brunt of it. But it’s also true for physicians as well.” “I will allow patients to put someone on a speakerphone, usually a family member or caregiver.” Naznin Jamal, MD Jefferson Regional Medical Center The end of the pandemic has lessened that hostility a ..read more

I’M NOT SURE if I am frustrated, disillusioned or just furious. Let me explain. I am a hospitalist in a decent-sized county hospital in Washington state. I split my FTE between direct patient care at the bedside and physician advisor. In my latter role, I am responsible for reviewing the incoming denials for patients’ “appropriate level of care” and deciding if it’s worth proceeding with a peer-to-peer discussion. That’s what payers offer hospitals, a chance to prove to the insurance plan that a patient clearly deserves to be admitted as an inpatient rather than be placed under observation st ..read more

I HAVE BEEN a practicing hospitalist for a decade now. Patients often ask, “What is a hospitalist? What do you specialize in?” I usually reply, “I am like your family doctor who works only in the hospital managing your overall care.” Most patients and families know little about the hospitalist’s role in their care, and it is not uncommon for me to hear patients say, “Oh, you are JUST the hospitalist. I am waiting for my heart doctor to come see me”. One morning, I picked up my patient rounding list as usual—and an uncommon name caught my attention. When I entered the dark room, I saw a young ..read more

IT’S A PERENNIAL problem in academic hospital medicine: Only seasoned and senior authors have protected time to do research, let alone write that research up and put together a grant proposal. According to Christopher Bonafide, MD, MSCE, an academic hospitalist in the section of hospital medicine of Children’s Hospital of Philadelphia (CHOP), his group does have a protected-time program. Clinical hospitalists who are accepted into that program can dedicate between 5% and 20% of their time to work on a research project for between six and 12 months. But as Dr. Bonafide points out, most academi ..read more

WHILE THROUGHPUT in hospitals has always been king, it is now—with staffing shortages, an aging population and consistently high volumes—more critical than ever. To meet that challenge, clinicians and staff at St. Mary’s Medical Center in Huntington, W. Va., the largest of the four hospitals in the Marshall Health Network, have in the past year put in place a series of throughput innovations. As Rob Hayes, MD, MHA, chief of the hospital-based specialties division and medical director of the hospitalist service, points out, that suite of innovations has cut length of stay in the observation un ..read more