Saturday, November 29, 2008
So starting today I will be known as a "PREHOSPITALIST". That my ticket. I see patient's before they get to the hospital and try to divert them before they get sick enough to be admitted. I see the sickest of the sick. End stage renal disease, transplant patients, double transplant patients, end stage copd, end stage chf, end stage anything, and frequent fliers.
Send them all to me. Send me your hardest patients. And I will bend over backward to keep them out of the hospital. I will see them weekly. Daily if I have to. I'll manage them aggressively. I'll return their phone calls promptly. I'll fit them into my schedule at a moments notice.
And I will manage them. Comanage them with their specialists. In fact I will call the specialists so often to discuss management that they will be sick of me. But I will cut their hospitalization rate down by 75 percent. And they will get better. And utilize less resources, and thrive.
Yet I will still see healthy people. And do annual screenings. And make unexpected diagnosis. And while I may not be an expert in any field I will still know enough about most fileds. And when death comes I will be there to comfort. And to advise. A jack of all trades.
And I will be what used to be known as an internist. Or a pcp. Back in the days when those titles garnered respect. But don't you dare call me that now! I am a "prehospitalist" to you bucko. And don't you forget it!
Posted by Jordan Grumet at 4:55 PM
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Dr. Grumet ... wow! Now I just need you to move to Maine/NH!!! :o)
Perhaps you could give lessons to other "prehospitalists"?
No way...The "Prehospitalist" Dr. Jordan needs to move to Virginia!
"Prehospitalist"...i love it!
Don't like it. Pre-hospitalist implies that everyone will eventually go to the hospital. Though we certainly do our best to prevent patients from needing hospitalization, this doesn't capture the bulk of what we do: screening, prevention, counselling, chronic disease management,etc.
"Hospitalist" became synonymous with "winner" because of the logistics-more pay, less paper work, flexible hours, etc. Until you fix the system, no amount of branding is going to help the situation.
I think what you are getting at in the term is what is becoming a clear separation between hospital medicine and ambulatory medicine. However, the term "ambulatist" just sounds bizzare.
For internal medicine, we do both inpatient and outpatient medicine. Therefore, internist PCP's could become "ambulatory internists" and hospitalists "inpatient internists." However the public still doesn't really understand what an internist does, and this leaves out our FP colleagues.
I guess I don't really have a solution other than to change the system. Nice attempt, but keep trying.
Great concept and can appreciate the the need to rebrand. PAs, especially in primary care do nothing akin to the traditional perception of "assisting." As a former paramedic though, I think that "prehospital" has already been claimed by EMS professionals who traditional do care for patients "prior" to hospitalization. The true "prehospitalist" would therefore be an EMS physician or other clinician. Since the AMA is pushing the concept of a "Medical Home" why not "Medical Homemaker?" Homemaker was a good rebrand for housewives in the sixties.
Please forgive me for leaving this comment here--I simply do not have any other way to contact you. I am a healthcare journalist with HCPro and would love to discuss this topic with you further for an article I will be writing for the March issue of Hospitalist Leadership Advisor. Please e-mail me at email@example.com to discuss.
Associate Editor, Medical Staff Division
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