Q: How has the practice of hospital medicine changed since you began?
A: Patients and families have become much more accepting of hospital medicine; they know their PCP won’t be coming in. For the most part, they are aware of hospitalists and [are] expecting us.
Q: Would you recommend hospital medicine as a career choice for a student or resident? Is there any specific advice you would provide them?
A: I would recommend it. I certainly find it worthwhile. The person who does well needs to be accepting of some uncertainty. [You] need to work well with other people, and you need some level of humility. If someone really likes spending time reading and being current and having lots of roles, it’s a good choice.
Q: Can you tell me about a patient encounter or teaching moment that stands out to you?
A: I had a patient who was on comfort measures only. I developed a good relationship with his wife. I was able to spend a lot of time with them and was able to help them with end-of-life decision-making. I was actually present when he took his last breath. I saw him open his eyes and look at his wife one last time and then he passed away.
He was unresponsive and on supplemental oxygen. I talked to his wife and said, “Let’s take it off, it’s not doing anything.” I knew it would be quick after that. It also gave her some measure of control. She wanted to be there. We took the oxygen off, and I sat in the corner. She talked to him, [and] he opened his eyes and gave her a quick smile and died.
Q: What are your major interests outside of the hospital, and how do you ensure you have time to do them?
A: I have five children, which takes a lot of my time. One of the nice benefits of HM is that it’s shift work, so there’s a defined amount of time that I’m working. I also try to be as efficient as I can at work so that I don’t need to work at home. As far as my interests at home, it’s time with the kids. Summer water sports are what we enjoy, so I try and take my vacations during the summer.
Q: What do you see as the future of hospital medicine?
A: Hospital medicine is here to stay. When I first started, there were questions as to whether HM would stick around. I think there are going to be more and more roles for hospitalists, and probably hospitalists that define certain areas of practice, especially in large institutions. I think subspecialist and surgery co-management will be developed further.
Q: Can you think of an HM “myth” that you feel your own experience has proven wrong?
A: There’s a common misperception that you don’t have continuity and don’t get to know patients. I have to say, every day when I’m walking in the hall, I have a patient I’ve cared for in the past call out to me and want to update me. I think [when you are] rounding on a daily basis on these patients, you get a few years’ worth of PCP visits. It’s a really concentrated interaction.
Dr. Bryson is a hospitalist, medical director of teaching services, and associate program director for internal medicine residency at Baystate Medical Center in Springfield, Mass. She is also an assistant professor of medicine at Tufts University.