I read a very interesting editorial from Annals of Internal Medicine by Dr. Beckman: “Three degrees of separation”. This article brings a very important issue of the ‘separation’ of the primary care physicians from their hospitalized patients. In his paper Dr. Beckman, overall, supported the hospitalist model, yet expressed his concerns regarding the lack of communication and collaboration between the hospitalists and the primary care physicians.

I work with a hospitalist group and, personally, I fully support the current model adopted by most hospitals in US. Medical care is becoming more complicated and specialized. New medications and technologies are constantly being introduced into clinical practice. There is no way to keep up with all the new developments unless you focus on a specific segment of the medical practice, like caring for the hospitalized patients.

I believe that the hospitalists are better ‘equipped’ to care for the hospitalized patients. I am not saying that primary care physicians provide inadequate care. It’s just that there will be enormous pressure on the entire medical system to become more efficient. Running between the hospital and the office might not be economically viable going forward. I see even more specialization in the future. Even within a relatively young subspecialty, like critical care medicine, the sub-subspecialties are being developed: neuro-critical care, cardiovascular critical care etc.

Having said all of this, I realize that the system is not perfect. Communication and continuity of care remains a major issue. It is not a good practice to ‘protect’ the patients from their Family Doctors. Collaboration and direct communication will enhance medical care and will keep the patients out of the hospital.
It is up to the individual hospital and the hospitalist group to develop protocols and directives facilitating direct communication. For example, talking to the PCP on a phone prior to the patient’s discharge home might solve some of the problems.

Dr. Beckman also brings an important issue of the misplaced incentives in our current system. I agree that doing paperwork and talking to the family on a phone is not reimbursed and, thus, not ‘encouraged’. We do it because we want to provide the best care for the patient and this should be driving our motivation.