By Eric Wolf Schoen
The way medicine is practiced in this country is constantly changing. Let’s face it. Most of the changes are made to cut costs which are out of control.
The role of private insurance companies is to maximize profits for those who invest in them. Other insurance companies have a role of minimizing costs for the institutions they work for. Bottom line is that decisions don’t always benefit the most important part of the medical equation: the patient.
I have a dear friend in the hospital. The friend has liver issues NOT as a result of alcohol or substance abuse. In fact the friend hasn’t had a drink since their 21st Birthday. Years ago your private doctor would follow you during your hospital stay and coordinate your treatment with specialists. There would be a hospital paid doctor available for emergency situations but most of your medical actions were under the purview of your doctor, referred to as Primary Care Physician or PCP.
Then in the lates 1990’s, someone came up with the brilliant idea of a Hospitalist. With administrative tasks piling up and life, in general, growing more complicated, over-burdened PCPs were finding it increasingly difficult to visit their hospitalized patients either before or after a long day of seeing patients in their offices. Hospitals reorganized in a continual effort to, they claim ‘improve inpatient care.’
Leaders realized it made sense to have in-house doctors who were general but specialized in taking care of hospitalized patients to replace a system that worked well for many years where your doctor handled your medical needs both in and outside of the hospital. For those with no doctor or run of the mill garden variety illnesses, the Hospitalist system probably works very well.
But for those with chronic, long term health problems like my friend with liver issues, the Hospitalist way of health care may not be the mode of medicine that works to their benefit. Hospitals employ these Hospitalists, many who have studied specialized fields of medicine to care for patients. But for the most part they come in with minimal if any knowledge of the background and health needs of the patient. This is a problem.
The Hospitalist could be someone assigned to a specific wing or section of the hospital for the 5 day workweek rotating weekends, or he/she could be a new person seeing patients every day. My friend is in a hospital where the Hospitalists change if not every day every other day. They report for duty in the morning, are given a list of patients to see and get a new list of patients every day they report for work. Continuity of care is lost, and the new Hospitalist has to review the records of those who preceded him before he/she can go to work providing needed health care services.
In the case of my friend, with rare occasions is the Hospitalist the same person every day. So the patient and family members have to review with the Hospitalist of the Day the patient’s background, medical history and current status. This can be quite taxing on everyone involved, repeating your story every day.
The most frustrating thing is when the Hospitalist asks patients about things that should be clear to him or her by reading the patients records. During the over a week stay of my friend in the hospital 2 Hospitalists asked my friend and asked me if the liver damage was caused by alcohol. It is clearly stated throughout the medical records that it is not. When this happens, I stop the conversation with the Hospitalist and ask him or her to review the patients medical records and after this is done, come back to discuss the needs of the patient. Bottom line when they ask ridiculous questions like this is they haven’t reviewed the records.
Does this type of care benefit the patient. Of course not. Is it upsetting to the family being asked the same line of questioning day in and day out? Of course. Is it good that there is someone at the hospital 24/7/365 to handle patient needs instead of hospital staff having to reach the Primary Care Physician who may be in the middle of treating other patients. Of Course! But with a new doctor everyday is there continuity of care for the patient vs. his or her Primary Care Physician coordinating care. From my perspective with my friend and other people I know, unfortunately not.
Is the Hospitalist a way for the hospital to make more money. Every time the Hospitalist visits the patient the hospital bills for services. Does the Hospitalist save insurance companies money. Yes.
Bottom line. As the friend of the patient do I see improvement in care. No. For everyone from patients to family members do I see a state of confusion and frustration with the new guy in town having to get up to snuff quickly on the history of the patient, particularly those with long term medical conditions? Sadly, yes!
My only advice to you is if you have a friend or loved one in the hospital, make sure he or she and you stay on top of their care. Make your presence known by visiting or calling the hospital and asking for patient updates daily. And remember, you can always request that a specialist who has treated the patient, has rights in the hospital and who visits patients in the hospital see your friend or relative. That one little thing in the case of my friend was the most important thing that offered continuity of care and made my friend feel better psychologically knowing someone familiar with their care was in whole or part directing it.
Most importantly, STAY WELL and OUT OF THE HOSPITAL!
UPDATE:
-You may remember that the Mayor’s Office told me they were waiting for the report from the Human Rights Commission on the January incident involving the female basketball game between students from Roosevelt High School and the Leffell School to convene a meeting of faith based and community leaders to discuss this incident and what can be done to be sure this doesn’t happen again. The Yonkers Human Rights Commission as of press time has not issued any report on this topic.
What I did find out from the contracted lawyer, Mark Fang who is in charge of the Commission. Is that his report is NOT AN INVESTIGATION OF THE INCIDENT but will be ‘A report to effectuate better relationships of the groups involved in the incident.’
Bottom line is that there needs to be better lines of communication between the folks in City Hall and those that they employ to provide services. As I have stated before, a report on an incident almost 4 months after it occurred was ridiculous. I am impressed in my conversation with Attorney Fang by his plan for community workshops and his goal to make the Human Rights Commission an important part of Yonkers City Government.
FUNNY OF THE WEEK: The release that I saw that Ken Jenkins, Deputy County Executive is endorsing his boss and the man he hopes to replace, Democrat George Latimer for Congress in the 16th District in New York against the incumbent. There was a rumor around town that Jenkins was supporting Congressman Bowman, and this puts that to rest. This columnist has been robust in his support for Mr. Latimer against the incumbent and expected that Mr. Jenkins who has his pay check signed by Mr. Latimer and who hopes to replace would be endorsing him too!
Reach Eric Schoen at thistooisyonkers@aol.com, or friend him on Facebook Eric Schoen…just look for him in the picture with Joan Rivers!
