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What is Hospitalist?

Dr. Alexander Shen Twenty years ago, the concept of a "hospitalist" didn't exist. Today, there are more than 30,000 hospitalists practicing across the country. However, outside the medical field, few even know about this fastest-growing of medical specialties. Pulse talked to Alex Shen, MD, medical director of the Hospitalist Program at Torrance Memorial Medical Center, and David Wallis, MD, a family and sports medi­cine doctor at South Bay Family Medical Group, to get more details.

Pulse: Can you tell us what you do?

Dr. Alex Shen: We serve as your primary care physician while you're here in the hospital. Our training is in internal medicine, which means we see all types of patients-people who have heart attacks, strokes, severe infections. We basically care for the patients when the decision has been made to admit them either from the emergency room or they've prereg­istered. We take care of them from that point until discharge.

Pulse: How did the hospitalist program develop?

Dr. David Wallis: There have been enough advances in medicine that allow us to treat certain conditions in a physician's office. These conditions used to require hospitalization 10 or 20 years ago. That's made medicine practiced in a physician's office a lot more complex and it's also increased the acuity level of those cases that do need to be admitted. Certain conditions physicians may see once a year, hos­pitalists see several times a week. They have a lot more expertise in some of the higher acuity conditions.

Dr. Shen: A lot of it has been driven by standardization of care within the hospital, ef­ficiency and cost-effectiveness-safety as well. All of those things put pressure on the medi­cal system, causing this sub-specialty to arise. There are fellowships in hospitalist medicine that have developed in recent years.

Pulse: Has the hospitalist program helped improve overall patient care?

Dr. Wallis: For the 99% of their lives that our patients are not in a hospital, they rely on us to be available to them in an outpatient set­ting. Ideally, we keep them out of the hospital entirely. The more time primary care physicians spend in the hospital, the less time we have to keep our patients out of it.

Dr. Shen: We're here all the time. We're answering pages and phone calls all day, all night. We're much more available physically to run up and see the patient right away. One of the biggest benefits to our program is that we are coordinating care. We're talking to the nurses, talking to the technologists for laboratory work and exams, bringing in subspecialists as needed. We really are coordinating from the moment you are admitted to discharge.

Pulse: Is there a downside?

Dr. Wallis: The biggest challenge is that the patients are really used to a personal physician who knows them and has cared for them over the years through thick and thin. When someone's being admitted to the hospital, that's when they are the most vulnerable and they miss the presence of that physician that they've known and trusted for so long. Fortunately, our hospitalists work very hard at making the transition comfortable.

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