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Up Close and Personal With a Hospitalist

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Steven M. Grant, M.D., is associate director of the Primary Care Hospitalist Program at Fletcher Allen, director of the Physician Career Center, and associate professor at the University of Vermont College of Medicine.

I’m not a fan of the term “hospitalist”. It’s not the job or the specialty that bothers me, it’s the name. It’s clunky to pronounce, difficult to explain, and sounds too technical, like a person running some kind of top secret healthcare matrix. I’d prefer something more gallant, something that better conveys the energy and enthusiasm of my field, but I’m afraid the name is here to stay. Which is too bad, because I take this hospitalist thing personally.

The term hospitalist was coined by Drs. Robert Wachter and Lee Goldman in a 1996 New England Journal of Medicine article. It’s defined as a health care provider who specializes in the care of hospitalized patients. The specialty – Hospital Medicine – is much like Emergency Medicine in that it’s organized around the site of care. Some people focus on an organ (like a Neurologist); others on an age group (like a Pediatrician) but hospitalists are all about location. Most of us are generalists – we trained in General Internal Medicine or Family Medicine – and our duties may include patient care, teaching, research, and administrative work. Like I said, it’s tough to explain.

Let’s try an example. Say you came down with pneumonia, a serious enough case that you required hospitalization. Twenty years ago – before hospitalists existed – you would have been taken care of in the hospital by your primary care physician. She probably would have visited you early in the morning, before she was scheduled to arrive at her outpatient clinic, where she had a full schedule of patients to see every 15 minutes. Any issues that arose at the hospital – a question about your medication, a relative who wanted an update, even a sudden deterioration in your condition – would be communicated to her by phone. Some questions would be easily answered but other problems might require her to drop everything and return to the hospital. Every call would place her in the same predicament: should she focus on the patient in front of her or you, lying in a hospital bed, perhaps miles away?

Now there are many forces that made Hospital Medicine what it is today – with about 30,000 hospitalists, Hospital Medicine is the fastest growing medical specialty in American history. If you listen to my podcast, you’ll know it’s not a tale of nobility. Financial pressures on hospitals and doctors played an enormous role. The bottom line is that no one can be in two places at once. In most cases, we need one person at the clinic seeing scheduled appointments and someone else at the hospital treating the sickest patients. And those two people need to work together to give every patient and family what they need.

Need is a big part of why I stayed in Hospital Medicine. I started in outpatient Primary Care on August 15th, 1996 – the very day Wachter and Goldman’s article was published. A few years later two of my colleagues – Drs. Jeff Davis and Mark Pasanen – started a hospitalist program at Fletcher Allen. I was ready for something different and decided to give it a try.

It was no surprise to find so many in need. My patients and families needed care, compassion and communication. My medical students and residents needed educators and mentors. My colleagues – generalists and specialists – needed all the help they could get. There was research to be done, committees to join, and projects and people to lead. It was dynamic, exciting and more than enough to hook me.

But something unpredictable kept me on the line. I had a wife, two young children, friends and neighbors, and so many others in my community that I needed. And they had friends and families, too. Fletcher Allen wasn’t just where I worked – it’s where every single one of us went when we were sick, a world famous academic medical center that doubled as our community hospital.

It didn’t take long to connect the dots. I took care of my friend’s mom, my neighbor’s friend, and my colleague’s brother. I trained a resident who delivered our daughter and a student who became my son’s little league coach. And I led projects and people that I was sure one day would save lives, maybe a first grade teacher, a trusted mechanic, or that friendly lift operator at Bolton Valley – you know – the one with the shaggy goatee. Maybe it was different in Boston, but this was Vermont.

Today I do what most people in my specialty do – a mix of patient care, teaching, research, and administrative work. It’s stressful, exhausting, and incredibly humbling. Some days I think I’m the luckiest person on earth.

I guess you can call me a hospitalist. Just know that I will take it personally.

Steven M. Grant, M.D., is associate director of the Primary Care Hospitalist Program at Fletcher Allen, director of the Physician Career Center, and associate professor at the University of Vermont College of Medicine.

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