Hospitalists practice a relatively new breed of medicine, where they typically only see hospitalized patients.
Before hospitalists came around, a hospitalized patient’s attending physician—the one with the ultimate decision-making responsibility—might only be in the hospital once a day for rounds. These days, most hospitals have hospitalists on-site 24/7.
Rehabilitation and skilled nursing facilities also rely on hospitalists to manage medications and other medical issues for their patients, although they don’t typically have a hospitalist on-site 24/7.
Blurry lines on who’s in charge
In hospital settings, hospitalists are frequently listed as their patients’ attending physicians and, in theory, make the medical decisions necessary to manage their care. In my experience, as a Houston, Texas, medical malpractice attorney, that’s not always the case.
Take surgical patients, for instance. When a patient is admitted to the hospital for surgery, the attending physician is usually a hospitalist, rather than a surgeon. When it comes to the reason for the hospitalization, though, the surgeon calls the shots. Beyond that, responsibilities get blurry.
Last year, I accompanied a family member to a hospital for a gallbladder surgery (cholecystectomy). She was admitted through the emergency room the day before the surgery. Late that night, a hospitalist poked her head in the door and introduced herself. I asked her about the status of some blood work and radiology reports, and she was completely clueless. While the hospitalist was quick to generate a bill for her unknown services, the only thing I can tell for sure that she did was sign off on the hospital discharge. The surgeon could have easily done that, though.
Hospitalists sometimes cause more harm than good
In my opinion, hospitalists sometimes cause more harm than good. Right now, I’m thinking of a hospitalist in the Sugar Land area whom I’ve sued a few times on behalf of his former patients.
One of my clients had fallen and hurt her back. She was admitted to the hospital for back surgery. The orthopedic surgeon ordered painkillers including the narcotic Dilaudid. After the surgery, the surgeon limited his focus to how her incision wound was doing and whether the overall surgery was a success.
The hospitalist, though, was the attending physician and was responsible for seeing her every day and managing her overall medical condition and medications. When the hospitalist saw the patient a few days after surgery, he dutifully noted in the medical record that she was acting out of her mind (what is referred to as an “altered mental status”) and was overly sleepy (“somnolent”). He even went so far as to note that he suspected that she was being overmedicated on painkillers. Yet, he didn’t discontinue the pain medications or tell the surgeon about it.
The sad end of the story is that the lady died because of a complication related to Dilaudid. When I deposed the hospitalist physician, he testified that he was the attending physician, but had no responsibility whatsoever for the painkillers.
Clarifying responsibilities among physicians
A medical malpractice insurance company for physicians published an interesting article on strategies to reduce liability risks for hospitalists. These strategies also provide insight for patients about what they can do to improve their own safety.
First, it’s important for physicians to understand their different roles and scope of care. I recommend that patients and family members talk to their doctors in the hospital about who does what. Ask about who’s the attending physician. Find out which doctor is in charge of medications. Inquire about who is responsible for addressing any complications.
Second, research shows that hospitalized patients are most at-risk during transitions in their care. Physicians, nurses, patients, and family members should be extra careful during these time periods:
· At hospital admission and discharge
· When the patient is transferred from one hospital unit to another
· When the patient is sent from his or her room to radiology or to a procedure room
· When care is taken over by a consultant or new physician
· When the primary or attending physician goes off duty or on vacation
Hand-off communications can help
When numerous healthcare providers are involved in a patient’s care and the lines of responsibility are blurry, extra communication helps. The Joint Commission, a nonprofit organization that handles hospital accreditation, coined the term hand-off communication to describe the critical information that should be passed off from one provider to a next, like a baton in a relay race. The idea is to make sure nothing falls through the cracks.
I recommend that hospitalized patients and family members have their own sort of hand-off communication in mind. Start by keeping a journal with the names and specialties of every physician involved in your care. Make a note of any laboratory or radiology tests that are ordered and why. This will let you follow-up with questions about the results. Any time a new physician gets involved, share in detail what led you to the hospital and what happened in your care up to that point.
We are here to help
If you or a loved one has been seriously injured because of poor surgical, medical, or hospital care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.