1. Home>
2. Reader Remarks

Reader Remarks on:

Physician Continuity from Outpatient to Inpatient Care Is Declining

• Continuity of hospital care
• Continuity of Care
• Decline in Physician Continuity
• Continuity of Hospital Care

Continuity of hospital care

Mildred M. Jensen, 1 May 2009 12:32 PM EST

Competing interests: None declared

During a hospital stay last August, I was seen by 10 different doctors, over a 4 day period, some of whom didn't even bother to intoduce themselves until I asked them to identify themselves. This is impersonal medicine and is totally unacceptable.

back to top

Continuity of Care

Peter C. Jamieson, Calgary, Canada, 1 May 2009 7:28 PM EST

Competing interests: None declared

The balancing measure that should be explored is access to community care and continuity in the outpatient setting. Prehaps the improved continuity and access that outpatients can achieve outweighs perceived disadvantages postulated here.

back to top

Decline in Physician Continuity

Martha J Lynch PA-C, 1 May 2009 9:17 PM EST

Competing interests: None declared

As with most trends which are adopted to reduce costs and maintain best clinical outcomes for patients, Hospitalist practice has detractors and advocates. The perspective from Dr Schwenk is beneficial to consider if the information is weighed within the current health care model of cost containment. Can we fairly measure the impact on hospitalized patients when their regular PCPs are not part of their inpatient care planning? Beyond that, how should we define the term "impact" ?

To be fair, using past claims submitted by ambulatory PCPs or Internists for a particular patient may provide raw data which is potentially misleading. It presumes an ongoing , even an exclusive, relationship between a particular patient and provider. Such a presumption may over-value the relationship in terms of its history, consistency and influence, or may lead to conclusions that are neither completely correct nor constructive to the discussion.

In the early 1990's I finished my Physician Assistant training and joined an Oncology practice, it was rare, if ever, to see any PCP rounding on any of our hospitalized patients. Not because we didn't ask and not because they didn't want to make hospital rounds. Rather, the time-driven demands of ambulatory Primary Care and the specifics of inpatient care seemed to become increasingly at odds with a goal of PCP participation with their hospitalized patients.

In each subspecialty where I've been a PA, I felt it was part of my job to send notes to the PCPs to advise of any change in a patient's condition or treatment , and always when a patient died. But I can't recall a single time that a PCP contacted me or any of my physicians regarding our treatment strategies. If they came to visit their patients, it was more like a social call than a medical call. That trend has only increased; more so , today, than even fifteen years ago.

Framing any conclusions might depend on collecting data that determines whether patients actually suffer lasting emotional or psychological harm from a "disconnect" with their PCPs during hospitalizations. Secondarily, is there evidence of further erosion in their relationship with PCPs as a result of hospitalization.? If so, maybe streamlining hospitalization to keep the money hounds at bay is costing much more then we acknowledge. Maybe it is just another "intangible" cost of progress.

back to top

Continuity of Hospital Care

Cynthia Rothschild, 3 May 2009 11:46 PM EST

Competing interests: None declared

My 86 y-o mother was admitted to our small local hospital from the emergency rm. in Aug, 08. I lost track of how many doctors she saw in 2 1/2 days. Every time a new doctor came on shift I would have to explain the whole problem all over again. There appeared to be no communication from one shift of doctors to the next. It was worse for my poor mother. She saw so many doctors she didn't know who was a doctor and who was a housekeeper! At discharge a prescription was supposed to be called in to the pharmacy. It didn't happen and when I called to inquire they had no records on the screen because the patient had been discharged! The whole experience was unacceptable. We have to do better than this.

back to top

Your Remark: