Most Challenging Aspect of Practicing Hospital Medicine?

It’s always nice to have large amounts of data to aggregate, but sometimes, it’s the anecdotes that can help clarify a situation even more than big data sets can.  As part of the SHM meeting, we had hospitalists fill out a survey, and one of the questions was:

What is the most challenging aspect of practicing hospital medicine?

The answers were surprising.  Many of them related to administrative burdens that are placed on hospitalists (this isn’t the surprising part – we’ve been helping hospitalists with some of these obstacles for twenty years):

1. Authorizations and reimbursements
2. Documentation/billing
3. Financial Constraints by admins
4. Discharge planning
5. The C-suite

However, there were a significant number of people who brought up the medical/social side of the practice of medicine:

1. Not having resources
2. Each patient is ill in their own way
3. Confronting death
4. Finding the right balance between delivering good patient care while meeting metrics
5. Lack of continuity
6. Having difficult conversations
7. Making long lasting connections that patients will remember
8. Caring for COVID patients, seeing them deteriorate, and not being able to do much
9. Balancing the needs of the patients and physician well being
10. Changing guidelines

So, setting aside for a moment why delivering good patient care is hard while meeting metrics (one would hope that the reason we have these metrics we’re trying to meet is to facilitate providing good care), we see a lot of core issues of the practice of medicine that our hospitalists are struggling with.  Helplessness in the face of illness or resource constraints.  Ever changing literature.  Balancing competing interests.  Poor continuity.  Establishing connections without long-term relationships.  We’ve been dealing with some of these issues for quite some time (and it’s a bit disheartening to know that they’re still problems), but some of them have really only been revealed during the COVID crisis.  I don’t think I ever expected to not have enough PPE or to watch multiple patients die alone or to have to give advice to patients with minimal data and an ever-changing set of recommendations.  This small set of anecdotes really helps highlight the areas that our hospitalists need help with.

At medaptus, we can help with administrative burden (I see you #2 in the top list).  We can help you with your billing/charge capture and your patient assignments, streamlining your workflows.  But we’re going to need system wide change if we’re going to address these other issues.