You are sick enough to be admitted to the hospital.

Maybe you came through the emergency department. Maybe everything happened quickly. You are frightened, exhausted, uncomfortable, and trying to understand what comes next.

Then a doctor walks into your room and introduces themselves.

You have never seen this person before.

You may wonder:

Where is my doctor?

For many patients, particularly older adults who remember a different model of healthcare, this can be confusing.

The physician standing beside your hospital bed may be a hospitalist.

And understanding what that means can make the hospital experience a little less bewildering.

What Is a Hospitalist?

A hospitalist is a physician whose primary focus is caring for patients while they are in the hospital.

The term itself is relatively new. It was introduced into the medical literature in 1996 as healthcare began moving away from the traditional model in which community physicians routinely cared for their own patients both in the office and in the hospital.

Today, hospital medicine is a well-established part of American healthcare.

Hospitalists evaluate newly admitted patients, manage medical problems during hospitalization, order tests and treatments, consult specialists, respond when a patient’s condition changes, and help determine when a patient is ready to leave the hospital.

In many hospitals, they are the physician responsible for coordinating the overall medical plan during your stay.

Why Did We Need Hospitalists?

Imagine a primary-care physician with a full day of office appointments.

Now imagine that physician also has several sick patients admitted to a hospital across town.

Something has to give.

As outpatient practices became busier and hospital medicine became increasingly complicated, trying to manage both environments became difficult and inefficient.

Hospitalists offered another solution.

They were already in the hospital.

They could see patients throughout the day, respond when something changed, communicate with specialists and become deeply familiar with the complicated workings of inpatient medicine.

The role wasn’t created because primary-care doctors stopped caring about hospitalized patients.

Healthcare changed, and the way physicians delivered that care had to change with it.

But There Is Something a Hospitalist Doesn’t Have

Your history with you.

A hospitalist may be highly skilled at treating the illness that brought you into the hospital.

But on the morning you meet, they may know you primarily through a chart.

They weren’t there when you struggled with a medication five years ago.

They may not know that you normally walk two miles every morning.

They may not know that you become confused whenever you take a particular medication.

They don’t necessarily know what “normal” looks like for you.

And that matters.

It doesn’t mean the hospitalist isn’t doing their job.

It means you and your family may hold information the physician doesn’t have yet.

Tell Them Who You Were Before You Became a Patient

Hospitals naturally focus on what is wrong right now.

Your oxygen level.

Your infection.

Your blood pressure.

Your lab results.

Your heart rhythm.

But one of the most useful things you can tell the hospitalist is what your life looked like before you arrived.

“I live alone and manage everything myself.”

“I normally walk without assistance.”

“My daughter handles my medications.”

“I’ve been getting weaker for the last month.”

“This confusion is completely new.”

“I haven’t been eating normally for weeks.”

Those statements provide context that a laboratory result cannot.

They help the physician understand not simply what is happening medically, but how far you are from your normal life.

You May Have More Than One Hospitalist

This surprises patients too.

The physician who admits you may not be the physician who sees you the next morning.

Hospitalists often work scheduled shifts or blocks of consecutive days. Depending on how long you remain hospitalized, your care may pass from one hospitalist to another.

Specialists may also come and go.

You may see a cardiologist in the morning, a hospitalist in the afternoon, and another physician the following day.

Each person has a role.

But from the bed, it can feel like a parade of unfamiliar faces.

If you don’t understand who is responsible for what, ask.

A very reasonable question is:

“Who is the main doctor coordinating my care while I’m here?”

You deserve to know.

The Most Vulnerable Moment May Be When You Go Home

Discharge sounds like the end of the hospitalization.

In reality, it is another transition.

The hospitalist has cared for you inside the hospital. Now responsibility begins moving back toward your primary-care physician, specialists, rehabilitation facility, home-health team—or sometimes several of them.

Medications may have changed.

New diagnoses may have been made.

Tests may still be pending.

Follow-up appointments may be needed.

And the people taking over your care may not have been standing in the hospital room when those decisions were made.

This is one reason transitions of care deserve so much attention.

Before leaving, make sure you understand:

• What happened to me?
• What changed while I was here?
• Which medications should I take now?
• Were any of my previous medications stopped?
• Are any test results still pending?
• Who am I supposed to see next?
• How soon should I see them?
• What symptoms mean I should seek help?
• Who do I call if something doesn’t make sense after I get home?

Don’t assume someone else will automatically connect every dot.

Your Primary Doctor Still Matters

Once you leave the hospital, reconnecting with the healthcare professional who knows your longer story becomes important.

Your primary-care physician may receive a discharge summary and other hospital records.

But a document is not the same thing as a conversation.

Tell them what happened.

Bring your discharge paperwork and current medication list.

Ask whether the hospital changed anything that affects your ongoing care.

And if you don’t understand why something was changed, ask.

You are not being difficult.

You are helping reconnect pieces of care that were temporarily separated.

The Hospitalist Isn’t the Problem

It would be easy to look at all these handoffs and conclude that hospitalists caused fragmented care.

They didn’t.

Hospitalists emerged partly as a response to a healthcare system that had already become too complicated for many community physicians to simultaneously manage a busy outpatient practice and hospitalized patients.

They fill an important role.

They are present in the hospital.

They understand hospital systems.

They manage seriously ill people every day.

But the model also reminds us of something important:

No matter how skilled the physician is, knowing the disease and knowing the patient are not always the same thing.

The hospitalist brings expertise in caring for you while you are hospitalized.

Your primary physician brings the history of knowing you over time.

Specialists bring expertise in particular diseases or body systems.

And you bring something no one else can bring.

You bring your life.

The best care happens when those pieces find their way back together.

References

Society of Hospital Medicine. What Is Hospital Medicine, and What Is a Hospitalist?

Wachter RM, Goldman L. The Emerging Role of “Hospitalists” in the American Health Care System. New England Journal of Medicine. 1996.

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Network. Transitions of Care.

American College of Physicians. Hospital Medicine and Transitions of Care.