Physician perspective: Respect thy hospitalist

"If this kind of thing is happening in three very different hospitals scattered across the country, it's fair to assume that it must be happening elsewhere."

For the last seven years, I have been focused intently on improving the experience of care for patients. I have not only had the honor of working at Cleveland Clinic, one of the most renowned healthcare systems in the world, but I also have had the pleasure of interacting with physicians and healthcare leaders internationally. 

In the last six months, I have visited three different hospitals where I was exposed to alarming insights about the internal interactions of some medical staff professionals. At one hospital in the Southwest, I was asked by the patient experience leader to sit down with their hospitalist group to discuss ways they might be able to improve their physician communication scores. It was a group of 12 physicians, including their division director. I talked for a little while about the importance of communication skills and we discussed some improvement tactics. Then I turned to the group and started with my first, standard question: "What do you guys see as the challenge?"

At first, the expected silence permeated the table and no one would make a comment. Finally one physician had the courage to speak up: "No one respects us." I was floored.

He went on to describe the challenge of taking care of patients when it was often difficult, and sometimes impossible, to get some of his other physician specialist colleagues to come see a patient and help manage that patient's care. He talked about how a particular cardiologist at his hospital would frequently ignore consults and not even return the hospitalist's phone calls or pages.

As this hospitalist shared his concerns, his colleagues confirmed his story and opened up about similar problems they've experienced. They described how, in some cases, even residents from some of the surgical services would not return their calls about patients.

At another hospital in the Northeast, I followed the same discussion outline and heard similar complaints from another group of hospitalists. This group talked about how some consulting sub-specialists give patients information without first conferring with the primary team or the hospital — the physician in charge of their care. They gave examples in which information shared with patients was misleading, and even wrong.

At the third hospital, the same themes emerged among hospitalists: lack of respect, poor communication and no returned phone calls. An especially egregious example emerged at this site. A hospital-led initiative to gain support for allowing hospitalists to help take care of older, medically complicated joint-replacement patients after surgery was rebuked by the orthopedic surgeons. The hospital administration believed having the hospitalists help manage patients in the post-operative period would improve the quality of care for these patients' chronic medical conditions — a reasonable approach given that orthopedic surgeons are not trained to handle complicated chronic disease. The orthopedists resisted, expressing their confidence that they — the bone doctors — were more qualified to manage diabetes, high-blood pressure and coronary artery disease than the hospitalists. 

If this kind of thing is happening in three very different hospitals scattered across the country, it's fair to assume that it must be happening elsewhere. At the very least, this behavior speaks to the lack of professionalism of some physicians and their inability to successfully communicate with their colleagues. It also gets to the root of how we are often challenged to deliver safe, high-quality, coordinated care in a patient- and family-centric environment. When physicians fail to work together and don't respect their physician colleagues, it is a safe bet that their interactions with other healthcare professionals, such as nurses, and patients are also compromised. 

I am a surgeon. My expertise on hospital medicine stops at knowing that when I have a complicated or sick patient, the hospitalist is the first one I call to help me out because they bring a critical set of skills to care delivery that I don't have. I have reached a maturity level in my practice to know my limitations, and I am well aware that I don't know everything.

Healthcare delivery today is complicated by a variety of factors, including a patient population that is older and who come to us with much more chronic disease. The challenge of managing these patients stresses the most agile medical mind. Our ability to successfully treat them with all of the up-to-date thinking and modern medical tools available to us is predicated on our willingness to ask our professional colleagues for assistance. Medicine is a team sport.

Professional courtesy starts at the top. It is the responsibility of hospital and medical staff leaders, as well as clinical directors of specialist and sub-specialist physicians, to eradicate this pervasive disrespect. Call it out, reject it, and work to develop a culture where professionals are aligned in the service of the patient. 

To clinicians who have personally experienced this type of behavior: Report it to your medical staff leadership. There is enough inherent suffering in medicine for patients and caregivers. We do not need to create more. 

About the author

Dr. James Merlino joined Press Ganey as president and chief medical officer of the strategic consulting division in 2015. As an accomplished surgeon and industry leader in improving the patient experience, Jim draws from more than two decades of health care experience to oversee Press Ganey’s consultancy division. Prior to joining Press Ganey, Jim served as chief experience officer and associate chief of staff at the Cleveland Clinic health system, as well as a practicing staff colorectal surgeon at the organization’s Digestive Disease Institute. At Cleveland Clinic, Jim was responsible for leading strategic programs to improve the patient experience across the system. Previously, Jim practiced at the MetroHealth System, one of the largest safety-net hospitals in the country. 

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