You’re a Hospitalist? You’re Ready
As a physician in the middle of a mass-casualty event, the media called upon Dr. Bowman to recount the events of the Tucson shooting. In more than a dozen interviews with local and national media, not once was Dr. Bowman referred to as a hospitalist.
“At the scene, when I kneel down, I am a doctor. Can you tell me what’s going on, can you talk to me? It goes no farther than that,” he says. “In talking with one of the interviewers, she asked, ‘What kind of doctor are you?’ I said, ‘I am an internist and a hospitalist, which is a doctor who works just in the hospital.’ They weren’t interested in that. When the cameras rolled, she said, ‘I understand you are an intern?’ I said, ‘No, I am an internist. Turn that thing off and start again.’
“That’s the level of knowledge you are dealing with, and that was a national anchorperson I was dealing with.”
It’s an all-too-common refrain for hospitalists around the country, but one Dr. Bowman and others like him have endured for years. It doesn’t bother him, and he says it shouldn’t bother others.
“Doctor or nurse was as far as it got. I can certainly understand that,” he says. “We explain what a hospitalist is every day. We’ve been doing it for 12, 13, 14 years, and people still don’t understand. It’s OK.”
What isn’t OK is hospitalist unpreparedness. In fact, Dr. Bowman says, his training as an internist and his years of HM experience played a pivotal role in managing the scene of the Tucson shooting. The first thing to do, in addition to remaining calm, is to keep your priorities straight and remember your ABCs.
Be ready. And, by the way, you are ready. You take care of a stroke patient in room one, take care of a gangrenous leg in room two, a diabetic with ketoacidosis in room three. The broadness, the generality of your training, you are ready to take care of a variety of things. You’re going to be able to help. Just be ready.
“It’s airway, airway, airway,” he says. “Without an airway, people don’t live. Then you are looking for bleeding, bleeding, bleeding. Then if they are talking, not a lot of bleeding and have a pulse, that is good enough for right now. So, it’s ‘Lady, just keep pushing on the chest right there on that wound.’ … I think, if you remember your ABCs, that’s all you can do in a field triage situation.”
Although the circumstances are less stressful, hospitalists are faced with make-or-break decisions every day, Dr. Bowman says. For example, it’s 4 p.m. and the day shift physician in the ED calls and says he has six admissions he’s been working on for the past three hours. “You, based on the info given to you, have to decide, Well, who is sickest, who do I have to get to first, who is going to the ICU?” Dr. Bowman says. “You do this triage thing in your mind as you walk to the ED. If there is any corollary, it’s the fact that you, as the hospitalist, get hit with a slew of patients all at once. They don’t come in one every 15 minutes like in your office for a blood-pressure check.
“Be ready. And, by the way, you are ready,” he adds. “You take care of a stroke patient in room one, take care of a gangrenous leg in room two, a diabetic with ketoacidosis in room three. The broadness, the generality of your training, you are ready to take care of a variety of things. You’re going to be able to help. Just be ready.” TH