Michael Kirsch, MD / October 27, 2019
Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.
The medical universe has changed. Hospitalists care for most hospitalized patients, which, in my view, has vastly improved the quality of hospital medical care. It is commonplace for patients who need to be seen right away in the office, to see a doctor who is available, who may not be the physician of record. Pregnant women today often see many obstetricians in the group since it is unlikely that the patient’s designated obstetrician will be on-call on D-day. One of Cleveland’s corporate medical giants boasts that they offer “same-day appointments,” which is true if a patient is willing to see a medical professional several zip codes away, not the patient’s actual doctor.
Understandably, if you call your physician after hours or on the weekend, you will most likely connect with one of your doctor’s partners. This is why it is not advisable to call the emergency on-call physician 9 p.m. for a conversation about your chronic arthritis.
Patients are now used to seeing strangers prescribing their medications and ordering their diagnostic tests. Hospitalized patients may be treated by several physicians they do not know. They have adjusted as best they can, but there are obstacles and drawbacks to this medical care paradigm.
It is unsettling for patients to be confronting several medical professionals for their care. Similarly, if you are reading 4 or 5 books at once, are you really able to keep the separate stories straight in your mind?
There is an unavoidable loss of continuity when there are multiple physicians at the table. Hospitalists do a great job. But, do we really think that all of the nuanced knowledge and objective data can be seamlessly transmitted to your primary care physician whom you will see after you are discharged?
What if different primary care physicians who are seeing the same patient have different opinions? Who does the patient believe?
Even in the computerized era, it’s astonishing how often new physicians do not have easy access other physician’s medical records. Does the weekend physician consultant who is seeing you in the hospital know that another doctor already ordered an ultrasound of the gallbladder a few months ago across town?
When there are too many physicians involved in a single patient’s care, medical testing and costs tend to increase, which does not increase medical quality. In my experience, a new doctor is more inclined to order a medical test than to advise watchful waiting, a strategy that the doctor who knows the patient well would more likely rely on. For example, if I see a patient I know for years with the same stomach pain, I may react differently than another gastroenterologist seeing him for the first time.
Oftentimes, patients and physicians meet as strangers. This reality creates many challenges. Both sides need to be understanding.