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Health and the Hospitalist Mentality

Times they are a-changing – yet some things refuse to change with them.

Private physicians and Hospitalists alike are bemoaning the state of care today, and it’s easy to see the funnel-cloud forming. From the local group practice office to the hospital CEO , there is an overwhelming pressure to reduce the flow of patient traffic, or to somehow regulate services in order to better support the health of the greater community. The ideas are well-placed, but the results just don’t line up.

The results are in. The majority of healthcare providers are headed for burnout, if they’re not already there. Overburdened schedules, piles of paperwork (or endless EMR screens), and the inability – or unwillingness – to direct patient care to an appropriate third party.

If you take an aerial view of the situation, it seems easy to see where it all went wrong. On one hand you’ve got the idea that ‘safety net’ programs and robust Primary Care networks will help the population that use a lot of services, and that’s largely true. However, it’s generalities like these that are not addressing the underlying disparity between patient’s true needs and the incentives that motivate providers. In a word, funds are still being allocated in the wrong places, and the people who need help the most aren’t getting it.

The down shot of these initiatives is that they are actually creating more work for the hospitals, the physicians and other caregivers – work that has absolutely nothing to do with their purpose in life. With so many polarizing ideas on how this should be reformed, from the community all the way to the Feds, it’s easy to understand the mounting frustration. The levee is groaning and the center will not hold.

The White Coat Factor

Physicians live and breathe the paradox of health. On one hand, they accomplish healing through medicines, technology and collaboration. On the other hand, we see increasing evidence to support that simpler remedies often have better results. Concepts like spending more time talking to the patient about social and lifestyle factors, or suggesting simpler and achievable changes that doesn’t necessarily require prescription – these are all things that have the dual bonus of supporting long-term health and keeping patients out of the waiting room.

And here is where the thoughtful physician (and CEO) asks the question: “But what if all my patients took that good advice and moved on to a healthier life?”

It’s natural that the next thought is: then the waiting room would be a lonely place – or at least, this is what many physicians and caregivers believe. It’s a classic case of ‘what’s good for you’ versus ‘what we’ve been doing for so long’, and ultimately, nobody wants to heal themselves out of a job.

In reality, this kind of thinking is misplaced. People will always need hospitals, people will always get sick and need to see their doctor or a specialist. By supporting comprehensive care and having a larger worldview of what benefits their patient’s health, both ideals can be realized.

Patients will be healthier overall, and less of a burden is placed on the system. Reliance on ‘safety net’ programs can be more purposefully directed, and the time spent in hospital or in the doctor’s office will be better spent.

Linking Health and Social Services to Affect Change

Often the biggest issues affecting health are non-medical. If doctors had the ability to refer patients to effective social support programs that would have a lasting positive impact on their health, would they? This false “scarcity mentality” belief is undermining their willingness to foment for change. It’s up to the doctors and hospitalists themselves to push this movement forward – not the bureaucrats approving the programs.

The lingering state of mind that ‘more is better’ is resulting in less value placed on the resources that are desperately needed. More doctors, more nurses, more medicines, more patients, more clinics is part of it – but how is that going to help if the patient does not truly change? All that is doing is throwing “more” at a problem that probably needs, at the very least, a significant shift of focus.

When the caregiver is able to focus more time and the right attention on the patient, everybody wins. And it is here that smart, courageous Hospitalists come it – to ensure that effective admission policies, evidenced-based medicine and meaningful discharge planning play their parts.

So once a doctor is able to participate in the holistic support the wellbeing of their patients, they will be more effective and thereby more likely to do more of what they are meant to do: just be the physician they dreamed of being before the storm clouds of burnout loom on the horizon.

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