The Merit of a Hospitalist
By Sidra Raza, MD

“Dr. Waheed, we were so happy to see your name on the schedule. We love having you on service on our unit,” says Jasmine, RN, as she shuttles her aides into the conference room. Kyle, PT, turns to the patient he is walking cautiously, “Dr. Waheed is one of our best docs.”

“Annie, your 11 am discharge metric this month was under the required percentage,” began Dr. Halaku, pulling my performance metric report out of a thick folder under his arm. A frown creased his brow, as he gingerly held it up by a corner, as if expecting the information on that sheet to jump out and attack him. “As you know, there is a hospital-wide initiative to sign the discharge orders on our patients before 11 to make the bed available for our next patient as soon as possible. Our census has been such that patients have been waiting in the ER overnight for hospital beds to open up.”

I handed Mrs. Sheldon a facial tissue, as she processed the news of her cancer coming back. Her daughter stood at bedside, wringing her hands in a mixture of anxiety and pain. The hands of the clock in her room also moved; steadily and creepily past 11 am. “I am sorry for taking up so much of your time. It’s just so –“, she stopped, unable to finish through a fresh wave of tears, her fingers gripping my hand tightly “I am here as long as you need,” I say, settling into the forlorn looking chair in her hospital room.

Metrics allow you to assign a measurable, standard value to something that may not otherwise lend itself to being measured. Like patient care. How do you decide Dr. A provides better care than Dr. B? Patient reviews are one way, usually. However, for a hospitalist, with no continuity of care, that does not translate into anything measurable. At least not the way hospital systems like to measure things. 

C-suite, non-physician executives like efficiency, patient turn over, and documentation. It gives them a value they can assign and then compare to other physicians in similar settings. And these end up becoming metrics of patient care. However, “caring for patients” is not the actual meat of the metric. If you want to be a “great hospitalist” per hospital standards, you ration time spent in each room, so you can finish all documentation in a timely manner. You ignore their anxieties and social situations preventing maintenance of health outside the hospital, and discharge them in time to reach your goals of length of stay and discharge order completion. 

Needless to say, I am NOT a great hospitalist. I spend too much time with patients. And too much time with non-patient personnel. Theoretically, we need doctors that enjoy what they do and spend time thinking about a patient they are taking care of. But practically, we make that virtually impossible. Unable to do anything to change this, most of us have started chalking this up as another undesirable occupational stress, as we go about our day, doing what we love best: patient care. 

Thinking back to a thoughtful card left for me by a recently discharged patient, I straightened my back and got up to leave my annual assessment. I am a “bad” hospitalist. And I love it. 

Dr. Raza is a guest writer for InCrowd. You can learn more about her here.

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