Hospitalists are internal medicine doctors, pediatricians and obstetricians who manage the care of patients admitted into a hospital.
Primary care physicians usually only see patients outside the hospital while hospitalists take care of patients when they are admitted. Data shows that hospitals that incorporate a hospital medicine model have decreased the costs and improved the quality of medical care.
Beginning of a Hospitalist’s Shift
At the beginning of a shift, a hospitalist receives “sign out,” which is the transition of information about patients from the previous hospitalist to the next hospitalist. During sign out, the incoming hospitalist hears a brief summary of each patient, relevant medical history and how the patient is doing, as well as updates on what happened during the previous shift and if there are any outstanding to do’s, such as following up on imaging results.
Next, the hospitalist spends time reviewing his or her patients in the electronic medical records if there are no urgent matters. A hospitalist can review why the patient was admitted to the hospital and the patient’s medical history, clinical course and current diagnostic and treatment plan. Additionally, the hospitalist may review lab and imaging results, comparing the most recent results with prior results.
Hospitalists then make a to-do list, prioritizing what tasks need to be accomplished during the day.
During a Hospitalist’s Shift
Hospitalist shifts can get busy depending on the patient flow, number of patients hospitalized and how sick the patients are. There are several tasks a hospitalist conducts throughout a shift.
Hospitalists go around the hospital to see their patients, commonly known as “rounding.” They prioritize sicker patients first. Doctors ask how the patient feels, look at vital signs and conduct physical exams. Then they discuss questions and the clinical plan with the patient.
Upcoming steps could include further tests, changes to medications or discharge plans. Nurses are by a patient’s bedside throughout the day, and hospitalists receive updates from them during rounds.
Discussions With the Medical Team
Other than the nurse, there are other medical team members hospitalists may interact with. Consults are specialized doctors in specific fields like surgery, cardiology, pulmonology and infectious disease. If a patient has a complicated lung infection, for instance, pulmonary and infectious disease consults may be required.
Other common individuals on a medical team include social workers, pharmacists, chaplains and child life specialists. Hospitalists often call patients’ PCPs to update them about hospitalizations.
Communicating with a patient’s family members is integral to patient care, and hospitalists update them and answer questions. Patients and their family members may ask for formal family meetings to discuss big medical decisions, such as discharge plans or end-of-life care.
When a patient is ready, a hospitalist discharges him or her from the hospital. The patient can go home with family members or to a skilled nursing care facility. A hospitalist ensures that all the correct medications are prescribed and writes discharge instructions.
A hospitalist also meets with the patient and his or her family to discuss follow-up tests, future appointments, what to do at home and what to expect during recovery. Excellent patient education is important.
Hospitals are often near capacity. Once a patient is discharged, there is space for a new patient to be admitted from the emergency department or to be transferred from another hospital. Hospitalists are responsible for admitting a patient, meaning that they talk to the doctor who has been taking care of the patient and learn about the patient’s “history of present illness,” the patient’s clinical course and treatments initiated.
Once the patient is transferred to the hospital floor, the hospitalist meets, examines and talks with the patient. The hospitalist writes a detailed admitting note summarizing why the patient is admitted. The hospitalist is also responsible for ordering all medications and lab orders.
At any point, the hospitalist’s pager might beep loudly. It is important to read pager messages promptly. Doctors can receive pages about numerous inquiries, including: a very sick and clinically unstable patient; codes; family members asking to chat; questions from nurses; new patient admissions; and consulting physicians who want to discuss and give updates.
End of a Hospitalist’s Shift
At the end of a shift, doctors sign out all their patients to the next hospitalists. Hospitalists are seen as shift workers, so they are theoretically off duty once they sign out their patients.
However, hospitalists may continue to follow the clinical courses of complicated patients through the electronic medical records. This allows hospitalists to hone their medical decision-making. There also may be remaining medical notes to finish.
Hospitalists’ shifts are busy, and they need to rest and recharge before the next demanding shift.
Learning Opportunities for Premed Students
Many premed students gain exposure to hospitalized patient care by shadowing hospitalists.
Additionally, premeds may meet hospitalists while volunteering in a hospital. Hospitalists can teach physical exam skills, such as how to listen for key sounds through a stethoscope, as well as how to read findings on imaging and diagnostic tests.
Hospitalists can also discuss the management of a patient’s diagnosis after the premed has spent some time with the patient, and can help the premed understand how hospitalists respond when a patient is experiencing organ failure as a result of disease.
It’s important for premed students to take the time to learn about the quality of life of hospitalists and how they invest time when they’re not seeing patients. There are many aspects of patient care and a hospitalist’s lifestyle that premeds can learn while working with a hospitalist.
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