What Is a Hospitalist?

Letters

The Power of Words

I enjoyed reading the December issue of The Hospitalist. I am somewhat concerned, though, about Dr. Pantilat’s continual assumption that all hospitalists are internists, which is far from accurate and alienates those of us with different board certifications.

For example, he notes that “any process of certification for hospitalists has huge implications for all physicians practicing internal medicine.” True, but certification has huge implications for all of us, including pediatricians and family physicians who are hospitalists. At these early stages of the specialty wording is important, and Dr. Pantilat needs to choose his phrases carefully. Many family medicine docs are choosing careers in hospital medicine. It would be a shame if family medicine hospitalists had to break away and form their own society.

—Robert A. Brockmann, MD, MSc, Englewood, Colo.

You are exactly right: The strength of hospital medicine and SHM is based on our “big tent” that embraces physicians who work as hospitalists (internists, family physicians, and pediatricians) in all settings—community practice, academia, and industry. Reflecting this diversity, SHM has a pediatrics committee and a family medicine committee to address the unique issues that arise for hospitalists in these specialties.

Regarding certification of hospitalists, the SHM Board of Directors decided to address certification for internists first because the majority of hospitalists and SHM members are internists. Our plan is to apply the approach for internists in family medicine and pediatrics to achieve equivalent certification processes for all physicians who practice hospital medicine.

The future of the SHM is predicated on the contributions of all physicians and other healthcare providers who care for hospitalized patients and work to improve that care. Our field and organization are strongest when we work together and use our unique perspectives and expertise to advance hospital medicine. Thanks for reminding us of the richness of our field.

—Steven Pantilat, MD, President, SHM

Communication breakdown?

I was disappointed that in the Dec. 2005 issue of The Hospitalist, you covered both the issues of malpractice (“A Malpractice Primer,” p. 1) and poor communication (“Say What?” p. 20). Yet other than a single mention in the latter article, no one connected the relationship between the two.

The Harvard study has shown that patients don’t sue physicians who practice medicine poorly more frequently than those who practice good medicine and, with regard to payouts or financial judgments, the correlation is to disability rather than negligence.1,2

Two more recent articles have shown that physicians who have higher patient satisfaction and a low complaint rate are sued less frequently.3,4 In our institution the most important component to overall patient satisfaction with the hospitalization relating to the physicians is how well the physician kept the patient informed. This, as your publication and others have noted, is a core function of the hospitalists. TH

—David B. Edwards, MD, FACP, Mesa, Ariz.

References

1. 1. Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245-251.
2. 2. Brennan TA, Sox CM, Burstin HR. Relation between negligent adverse events and the outcomes of medical-malpractice litigation. NEJM. 1996;335:1963-1967.
3. 3. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA. 2002;287:2951-2957.
4. 4. Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;108:1126-1133.