Hospitalists and the Doctor-Patient Relationship
Posted: 10 Aug 2004
Hospitalists-physicians who focus their practice on the care of hospitalized patients - are increasingly being used to care for patients hospitalized with general medical conditions in the U.S., often displacing primary care physicians from what had previously been their domain. While most countries other than the U.S. have had similar systems for at least a century, this is among the most important and controversial changes in the organization of care for hospitalized patients in the U.S. in many decades. While advocates of the hospitalist movement point to evidence of cost-reductions and perhaps improved acute outcomes, critics question whether cost-savings or long-run outcomes are truly improved, and whether there may be insidious effects on the nature of the doctor-patient relationship that may ultimately undermine the quality of health care. This paper attempts to define a framework for addressing these questions, assess the available evidence concerning those questions, and identify a research agenda to better understand the implications of the hospitalist movement as it relates to the doctor-patient relationship. Using a framework that emphasizes the roles of both general and patient-specific knowledge as crucial to a successful relaitonsip between doctor and patient, the paper argues that the hospitalist movement is in fact highly consistent with widely accepted patterns for structuring the doctor-patient relationship elsewhere in medicine. Seen from this perspective, the success of the hospitalilst model will depend on its ability to continue to develop its areas of technical expertise as a discipline while identifying strategies to work with patients and their primary care physicians to ensure care that is both continuous and appropriate to the needs and values of individual patients.
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