Hospitalists Focus on Inpatient Care [Dr. Cathy Leadabrand]

I'm Dr. Cathy Leadabrand. I'm a hospitalist here at Brookings Hospital and I take care of patients from the beginning of the time they're admitted, through their hospital stay and the time they're discharged.

Why Did You Become a Hospitalist?

I had actually worked in a general clinic setting, traditional internal medicine for about 11 years. So I would see people at the office and then also run over to the hospital, but my practice didn't have enough doctors to cover both places and with medicine becoming so complex and so fast paced, it became increasingly hard to be in several places at once. So, we started a program where some of the doctors broke off and covered the patients when they were in the hospital and then the others stayed at clinic, and I enjoyed it so much I've stuck with that. There's a lot of the younger hospitalists haven't...they've trained specifically just to go out and do hospital medicine.

What Benefits Do Hospitalists Provide Patients?
 
The first thought that patients have is that they would love to have their doctor there in their most vulnerable time, both at the clinic and at the hospital, but it's just not realistic. Even if the doctor can be there, then a lot of times, that doctor is spread really thin. So, with a hospitalist program, you've got a doctor there in the hospital most of the day, if not all of the day. If they see them in the morning and then if a problem arises, they can be right there to address the problem. And I've also found that if patients often...problems can present differently depending on the time of day. So some patients, for instance, get real confused at night. So it's really nice if I'm there in the evening hours, I can really see that that's happening, whereas before, if I were at the clinic doing dictations or home eating supper, I might miss that as a primary doctor.

How Do Hospitalists Collaborate With Primary Care Physicians?
 
I really like to keep them involved and the...sometimes you'll have a patient, for instance, they're at the end of life and medicine isn't black and white. And some decisions are very hard to make. We try our best to help guide and give them the information they need, but sometimes, I'll call their primary doctor just to let them be involved and it can be extremely comforting to the patient to know that they're on...to talk with them during those stressful periods. So that's one way that I'll use them.

Also, they're notified when the patient becomes admitted and they have access to our computer system, so can check up on the progress. If, for instance, they're an outlying primary, they can certainly ask for the records any time or we can give them an update. I've done that before, where a doctor will call and I'll give them an update on what's going on. By the same token, sometimes, I won't be figuring out what's wrong, it's real complex. I might call their doctor and say, "Hey, do you have any insight into what might be the bigger problem here?"

And then when they leave, we communicate with their primary physician to, sort of, pass the torch and let them try to transition them back to the outpatient care.

What Can Patients Expect From a Hospitalist?
 
First of all, they're admitted, and that might either be from the clinic or from the emergency room, and then they arrive up on the floor. We've been called and often I'll see them down in the emergency room, or if they're coming from the clinic, I'll see them after they arrive on the floor. The nurses at the same time have gotten them settled in the room. The pharmacists have come and talked over their meds. We'll examine them, take their history, try to determine what their problems are. Often, I'll get outside records or I've often talked to their physician if the physician's admitting them, to tell them their initial thoughts at the clinic. So that's, sort of, the admission part of it.
 
Then we look over...often, we'll get studies, blood tests, sometimes x-rays, sometimes other specialized testing. We look over that. We have our exam. We try to make a decision of what the best treatment plan is. On subsequent days, we round on them. So that would consist of usually in the morning, we'll have looked over some of their labs. If they've had problems overnight, the coordinator will have let me know about that, or the nurses let me know, and then I'll go in their room and examine them. Sometimes, the rounds are later in the day, too. It sort of depends on other patients that may be coming in, but we'll round in on them, examine them, and then try to assimilate that and determine what the next best step is. Sometimes, they are able to be discharged home to follow up with their regular doctor. Other times, they need to stay in longer and have more testing and more treatments.

What Follow-Up Care Do You Provide After a Patient Is Discharged?
 
It's sort of a transitional period, that 24 hours. We're available for phone calls, clarification. If the patient's having acute issues, typically, they need to go right through their primary care or if it's after hours, often, they'll be directed to go to urgent care or the ER. But we always...any tests that are outstanding get pushed to both us and their primary care. If there's confusion on the discharge meds, we often get calls from the pharmacist or their nursing. Here, we have so many elderly patients. Many of them have a home health nurse or that's helping to coordinate that transition.