Geno J. Merli, MD
Potential Financial Conflicts of Interest:Consultancies, Honoraria, and Grants received (Aventis, Astra-Zeneca, Bayer).
Requests for Single Reprints: Geno J. Merli, MD, Jefferson Medical College, Thomas Jefferson University Hospital, Suite 701, 833 Chestnut Street, Philadelphia, PA 19107; e-mail, email@example.com.
Merli G.; The Hospitalist Joins the Surgical Team. Ann Intern Med. 2004;141:67-69. doi: 10.7326/0003-4819-141-1-200407060-00017
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Published: Ann Intern Med. 2004;141(1):67-69.
The principal providers of medical consultation for the surgical patient have been internists, family practitioners, cardiologists, and pulmonary physicians. The model for the medical consultant's roles and responsibilities in the care of this patient population has been to provide the surgeon with an assessment of medical problems and concise recommendations on the management of patients in the perioperative period (1). Sometimes, the surgeon retains full responsibility for carrying out the recommendations. Alternatively, the consultant serves as a comanager for all medical problems. A point of demarcation between these 2 models of consultation is the hospital setting. In community hospitals, the comanager model is the predominant practice, whereas in academic medical centers, the pure consultant approach is used. The existence of these 2 models raises a question. Do the 2 approaches differ in postoperative outcomes, such as length of stay, medical complications, surgeon and nursing staff satisfaction, and costs?
Javed M. Gilani
Christiana Care Health Systems, Wilmington, DE
October 9, 2004
Applying the lessons from hospitalist co-management to primary care physicians' involvement
With regards to the article and accompanying editorial [1,2] regarding medical and surgical co-management in the hospital, we wish to make the following observations. The common-sense benefits of a co- managed team are clear in that communication is likely to be improved and result in better, more efficient care in the short-term. In this study, patient outcomes appear to be better as well. However, an important point is that in this study, the patient's long-term primary care physician (PCP) appears not to have been involved. It would be interesting to know whether patient satisfaction with care under the model described would differ compared with management by the surgical team and the PCP.
The fundamentals of good communication between teams and individuals cannot be overstated. This applies to discussions between on-site hospitalists and distant PCPs, as well as between specialty and primary care members of a patient's care team.
It has previously been suggested that some patients prefer their PCP to discuss with them important in-patient options, such as the need for surgery; as well as important information such as a terminal illness. We suggest that, rather than advocating solely for the joint hospitalist- surgical model, the principles from this study should also be applied to the model where the PCP sees the patient rather than the hospitalist physician. We further propose that, were meaningful communication be made explicit, improvements in care similar to those described in this study could be achieved, while also enhancing patient satisfaction by having their long-term PCP participate in their hospitalization.
1. Huddleston JM, Long KH, Naessens JM, Vanness D et al. Medical and Surgical Comanagement after Elective Hip and Knee Arthroplasty: A Randomized, Controlled Trial. Ann Intern Med 2004; 141 (1): 28-38.
2. Merli GJ. The Hospitalist Joins the Surgical Team. Ann Intern Med 2004; 141 (1): 67-69.
3. Pantilat SZ; Lindenauer PK; Katz PP; Wachter RM. Primary care physician attitudes regarding communication with hospitalists. Am J Med 2001; 111(9B): 15S-20S
4. Hruby M; Pantilat SZ; Lo B. How do patients view the role of the primary care physician in inpatient care? Am J Med 2001; 111(9B): 21S- 25S
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