Compromised Hospital Care

Most primary care physicians (PCPs) who admit patients to a hospital are family practitioners or internists.  Since medicine becomes more complex each day, PCPs must remain up-to-date on the latest treatment related to drugs, surgery, procedures, risks, complications, and costs. This might require your PCP to be a quarterback bringing together a team of consulting specialists to guide you through your hospital stay.

The economics of hospitalization are changing, and since you or your loved one upon admission are already challenged by the physical and emotional threat of illness, I bring you a cautious forewarning how your hospital care may be compromised.

Some PCPs are being told not to have consulting specialists see their patients.  Why?  It saves money, and decreases the length of stay (LOS) of the patient.  These PCPs are employed hospitalists, typically just out of training with high education debt, young families, and new mortgages.  It is easy for their medical group to dangle their contract forcing financial decisions, instead of medical decisions.

A recent example was the WWII veteran who stayed in the hospital for 2 days after passing out and falling, and found to have a pulse of 40.  He was sent home without a cardiology specialist seeing him, forcing his return 3 days later with the same symptoms and a pulse of 30.  Immediately, I had a pacemaker placed in him.  The previous discharge summary by the PCP hospitalist stated he was to see the cardiologist as “an outpatient.”

If you are hospitalized with chest pain, a stroke, major chronic pain, or heading toward end-of-life, you would expect physician specialists to be involved in your case.  But at some hospitals, certain PCP hospitalists “consult” nurses to see you instead of MD specialists…to save their medical group money and LOS.

This practice has been “enabled” by hospitals who have supplied nurses allowing them to see patients under the guise of being specialists.  They might be nurse practitioners, “navigators”, or have a specialty title.  Granted, some have textbook knowledge, but most do not have the decades of experience a practicing physician might have.  (I have even noticed they do not put “progress notes” on the medical record, making scrutiny of their expertise difficult.)

So there is a possibility if you come to a hospital with chest pain and the emergency doctor feels you need be admitted, you might not see a cardiologist before being discharged home.  Should you have a stroke, you may not see a neurologist.  If you have chronic unremitting discomfort, a pain management physician might not be involved in your case.  And should you or your loved one be at end-of-life, that discussion may never take place with a Palliative Care physician.

Veiled policies and procedures created by hospitals furnish subordinate patient care to be used by select PCPs to the detriment of yourself or loved one.  Using this cost-cutting technique enhances hospital profits benefiting administrative salaries. 

Are you prepared for this tactic to be used against hospitalized patients?  Validating specialists involved in your care assures opinions rendered are based on worthy education and experience.

Going to a hospital means the best available care should be provided. Since though administrators have taken over medical decision-making, one must be wary patient care may be deliberately usurped by self-serving profiteers.

Admission to a hospital already imparts a sense of physical and emotional threat to our personal well-being, but your worries should not have to include compromised care.

Gene Uzawa Dorio, M.D.