Primary Care and Hospitalists: Can't We Just Get Along?

Shelly Reese


March 28, 2016

A Relationship That Could Improve

The state of the relationship between hospitalists and primary care physicians has hit a nerve.

In her video, "Primary Care and Hospitalists: Improving the Relationship," Dr Pegus, director of the Division of General Internal Medicine and Clinical Innovation at New York University Langone Medical Center, underscores how two forces reshaping the face of medicine—the rise of hospitalists and the consolidation of outpatient practices into larger heath systems—present an opportunity to enhance care by improving physician communication.

But there's a challenge. The situation is not quite there yet.

In their comments about Dr Pegus' video, frustrated physicians indicated that the open communication and coordinated care she describes are not yet the reality they experience. As for the professional collegiality Dr Pegus describes, that may be even more aspirational.

What's the Ultimate Vision?

The vision of a collaborative relationship depends upon hospitalists and primary care physicians working within a given health system having access to the same information. In addition to a common electronic medical record, they need a shared understanding of the evidence-based guidelines standardized throughout their health system. They need training programs that educate physicians about the tools available to them; face-to-face meetings and onboarding events so they can meet each other; and clear, supportive messages from leaders underscoring, "This is how we're all going to work," she says.

"Because these physicians all work within the same health systems, it's extremely important that there are great communication modalities set up so that all of the physicians within a health system are hearing the same message," Dr Pegus says.

The Feedback: When Will This Become a Reality?

Logical though the message and the ultimate outcome may be, many Medscape readers say that closed-loop communication system doesn't yet exist.

"It would be wonderful if the system worked as outlined, but it doesn't," writes one internist. "The ER doc admits the patient. The hospitalist basically does a holding job and passes the patient off to another hospitalist in the manner of a shift worker. Each doctor seems to assume that the other doctors have contacted the primary doctor for an in-depth discussion."

Frustrating as that may be for physicians, it's even worse for the patients who get the runaround, the writer complains, citing the case of one of his own patients. She "told me that a hospitalist came into the room, did not touch her, and said he'd be back. He never came back." Instead, a second physician cared for her after a specialist said that she could be discharged. Yet another hospitalist came and discharged her. "Then she came to see me. The ER note and the specialty consult gave me the info," he writes. "The EHR info is generally useless."


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