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It's an emerging trend, and one that many patients find confusing and uncomfortable: their primary doctor doesn't visit them in the hospital any more and doesn't manage their hospital care.

Primary care doctors are increasingly turning the care of their hospitalized patients over to specialists called "hospitalists."

The hospitalist is a hospital-based doctor who does not see patients in an office-based practice. He or she manages the care of patients only while they are in the hospital, turning them back over to their regular physicians when they are discharged. During the time a patient is in the hospital the hospitalist is responsible for all decisions about a patient's care.

Advantages of Hospitalists

The hospitalist usually knows the hospital, and hospital politics, very well. This often enables the hospitalist to cut through red tape and "make things happen" more efficiently than office-based physicians.

Hospitalists are more readily available to respond to emergencies in the hospital. Nurses and other care staff can usually reach a hospitalist more rapidly than an office-based physician, especially on evenings and weekends.

Continuity of care within the hospital is often better. When primary care physicians manage inpatient hospital care, the patient is often actually seen by more doctors, as doctors in larger practices often take turns seeing all of the practice's hospitalized patients.

Hospitalists are usually more accessible to family members. Families don't have to try to "catch" the doctor in the wee hours of the morning or late in the evening when he or she is making hospital rounds outside of office hours.

Disadvantages of Using a Hospitalist

The biggest disadvantage to the movement toward hospitalists is the loss of continuity of care between the primary physician and the hospital. The hospitalist has no previous knowledge of his new patient. If communication between the primary care physician and the hospitalist is poor, it falls to the patient and the family to fill in the gaps.

When a patient is discharged from the hospital the hospitalist relinquishes care back to the PCP. If communication has not been good, the primary care physician often has little knowledge of what the patient experienced in the hospital. Records are frequently slow to follow the patient, so on the first follow-up visit the office-based doctor may have scant information.

Without adequate information the PCP frequently makes adjustments to treatment plans and medications that are counter to the treatment plans initiated in the hospital.

How To Work With A Hospitalist

Be prepared. If your trip to the hospital is pre-planned, talk to your primary doctor about the hospitalists in your chosen hospital. Find out which hospitalist communicates best with your doctor, and who your doctor prefers to work with. If possible, ask your doctor to pre-arrange that this hospitalist will be in charge of your care while you're in the hospital.

Arrive Armed: Never assume that things will go as planned. You may not feel well, and you will be under stress. The chosen hospitalist may be on vacation, out ill, or unavailable. Take a synopsis of your medical history, including the results of all recent tests, with you to the hospital. Whenever possible have someone stay with you in the hospital until you have met your doctor and given him or her all the information you have. Have that person take notes, including the names of all your hospital caregivers, their contact information (phone and pager), and the location of their offices in the hospital.

Sign a Release: If you can, make sure to sign a release of information form when you are admitted. This will give the hospitalist and everyone else on your medical team permission to discuss your care with the person you appoint. Even if you have already given that person your Power of Attorney for Health Care, signing a permission to release information is a good idea. You might not be so ill that your Power of Attorney for Health Care goes into effect. In that case, without authority to release information, you might find the staff is less than willing to share information with the person staying with you.