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Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Today we're going to learn together the role of a hospitalist physician. We've heard this term before, but not really quite sure what their role within the hospital system is. Joining me today is Dr. Silpa Yalamanchi. She's a hospitalist physician at Henry Mayo Newhall Hospital and a member of the Hospital's Medical Executive Committee.

She also chairs Henry Mayo's Department of Primary Care. Dr. Yalamanchi, thank you so much for joining us today. So, like I said, we've heard this term, what is a hospitalist physician?

Silpa Yalamanchi, MD: Thank you, Melanie. It's an honor to be on your podcast. Yeah, so Hospitalists are essentially physicians who have completed their training either in internal medicine or family medicine and are practicing hospital medicine as a medical specialty dedicated to the medical care of acutely ill hospitalized patients.

I understand why it's a relatively confusing term because we generally introduce ourselves as either your attending physician or your admitting physician or your medical doctor, when we speak to our patients that are hospitalized. Traditionally, when people went to the hospital, they expected to see their primary care physician who they saw in the outpatient setting, and then they see them in the hospital, and then once they get discharged, they see their primary care physician again.

So this hospitalist term was introduced in 1996. It was published in a paper in New England Journal of Medicine, where they coined the term hospitalist because the field started when the primary care physicians were getting very busy with their office patients and they, so they started to rely on physicians that were dedicated just to the hospital to care for their patients.

And that role has expanded to even patients that come through the ER that don't have a primary care physician. And we essentially act as their doctors or their primary care physicians in the hospital. A lot of times some of the patients that come through the ER we're probably the first doctor that they've seen in decades.

So, that's where the term hospitalist comes from. Essentially, physicians who are practicing hospital medicine, for acutely ill hospitalized patients.

Host: Wow, isn't that interesting? So you have to be trained in a very broad range of many different specialties because if you're seeing people not only in the ER, but also when they're in their rooms and making rounds and such, there has to be so much knowledge there. Tell me a little bit about the training for hospitalist physicians.

Silpa Yalamanchi, MD: Sure. As I mentioned, most of the hospital physicians, adult hospital physicians are trained in internal medicine or family medicine. And this is the same training that you receive when you go see your primary care physician in the outpatient setting. But we have dedicated ourselves just to the hospital. So as hospitalists we're the constant presence for the patients while they're in the hospital from admission to discharge. So the training is the same as you would get as an internal medicine or a family medicine doctor, but essentially we focus only on patients when they're in the hospital.

Host: So is every patient in the hospital cared for by a hospitalist physician? Are there some that you don't see?

Silpa Yalamanchi, MD: Yeah, there's still, at Henry Mayo, there's still primary care physicians who are still practicing the traditional route where they see their patients that are admitted from their office and they take care of them in the hospital. We pretty much take care of, I would say, majority of the patients.

So if you unfortunately have to be admitted to the hospital, the chances are you will likely see a hospitalist during your stay. We, patients are evaluated in the ER and then when the ER physician decides that they need more care, they need to be admitted to the hospital, they call us and we admit the patient.

We care for them from admission to discharge. We consult any consultants that are needed for a particular case. And it's actually quite important because our focus is completely on providing the comprehensive evidence-based care for what's needed for any particular patient. So we see a wide range.

We can see patients that come in for pneumonia that just need IV antibiotics through ICU intensive care units. We take care of ICU patients as well. We see post-op patients, we're consulted on ob gynecology patients, we're consulted on trauma patients. So we see a wide range of patients.

We're also consulted on behavioral health, psychiatric patients. So our training is, jack of all trades. So we have wide range, but we have to recognize what each patient needs and have the appropriate specialty consulted to continue the care that they need. We also have to order certain tests and make sure the appropriate tests are done for the right diagnosis and create a treatment plan for the patients itself.

A lot of times these patients don't see a doctor, like I mentioned, for decades and they come in sick with one thing and we end up diagnosing them with multiple other new diagnoses. So we act as their primary care physician and we give them a treatment plan and we coordinate to make sure that they have a primary care physician that they follow up with in the outpatient setting after they get discharged.

So when we see them for the first time, whether it's, it's a patient that has a primary care physician or not a primary care physician, we're meeting them for the first time. So we have to build trust immediately, build these relationships quickly. Because it's a short period of time while they're hospitalized, that we interact with them and we don't see them after they get discharged.

Host: That's a good point that you made, doctor, about the relationship because it is hopefully short term and then after discharge they work with their primary care or specialist. I'd like to speak about the specialist for a minute. Because you mentioned it. Can you expand? So if someone's had a heart attack. They need cardio. How do you communicate with that specialist? So now they've got more than one doctor. They've got this cardiologist working with them, but also the hospitalist physician. Tell us a little bit about how you all work together, and that includes maybe their primary care. How is that communication so cohesive? So you're all working together for that real multidisciplinary approach for these patients?

Silpa Yalamanchi, MD: And that's right, and I like to call it the trifecta effect here. We do act as the patient's primary care physician, and if they have a primary care physician, we can communicate with them easily to see, get their past medical history, surgical history, any kind of things like allergies that they may have, or other treatment plans that have worked or have not worked.

And for example, if a patient comes in with cardiac issues, a lot of times it may have a cardiologist in the outpatient setting, and if that cardiologist is available, in the hospital, we consult them. So it's a continuity of care from the outpatient to the inpatient. So you have your primary care physician, you have the hospitalist, and you have the consultants, appropriate consultants for each case that are involved.

And it is multidisciplinary. And we all work together, like I mentioned, to make sure that we recognize what tests are needed that are only available in the inpatient setting, or if it's these patients are acutely ill, so a lot of them are, it's emergency, so we need to make sure we get the right tests done in the inpatient setting to get the treatment plan going.

And after we've stabilized them in the inpatient setting, we discharge them back to their primary care physician and we communicate what was done with the primary care physician in the hospital with the primary care physician so they can continue the care that they need in the outpatient setting.

Host: Doctor, what do you say to patients that say, oh, well, you're not my primary care, or you're not the specialist. You don't know me. I mean, obviously you're taking copious notes and those notes go into the eMedical records now, right? So everything is there for everyone to look at, and since this is a new-ish field, what do you tell patients about the fact that you know what you're doing and you work with them specifically so that you can coordinate all of the things that go on in the hospital because there's so many moving parts.

Silpa Yalamanchi, MD: Yeah, so when a patient is ready to be admitted, what we do is we review their chart and a lot of times patients might have history in the hospital, so we review their past medical history. Look at their notes from previous admissions and when we interview the patient, we introduce ourselves saying, we're the hospital physicians.

They know that they've never met us before, but we tell them that we've reviewed your chart. This is what I gathered. Is there anything else you want to tell me? What is your purpose for your visit today to the hospital and essentially that trust building and is very important. And letting them know that we have reviewed their past history. I think that's where the trust starts, knowing that we know what has happened in the past, that they don't have to repeat their whole history again. That's very important. And now as you mentioned, the medical records are available for everyone to see.

So when while the patients are in the hospital, we tell them, look at your patient portal that they have access to, and if there's a lot of times they can see their tests directly, their labs directly while they're in the hospital, which is very convenient for us. When we go in, we could just sit down together and explain to them exactly what the labs mean, exactly, what the tests mean, what the next steps are, and what it's going to take for us to get them safely out of the hospital.

And once they get discharged, they have access to these medical records. And if they don't have a patient portal, which is electronic on their phone, they can always get their medical records sent to their primary care physician. So the primary care physician also knows exactly what happened in the hospital for them.

Host: You're such a vital part of the hospital community, Dr. Yalamanchi. So I'd like you to speak to the community for just a minute. What would you like them to know about hospitalist physicians and their role at Henry Mayo Newhall Hospital and why it's so important that they understand your role? So they know that they are really getting the very best care?

Silpa Yalamanchi, MD: So yes, you're absolutely right. We are definitely a vital role, not in just the medical care as far as comprehensive medical care that they need while they're hospitalized. We also play a very vital role in care coordination. You know what happens day to day? We work with case management based on what their insurances have available for them once they get discharged.

Do they need any home health services after they get discharged? If they can't go home right away, do they need to go to a facility such as a skilled nursing facility or a rehab facility? So we're very actively involved in care coordination with the case management. We manage day-to-day medical care as well as whatever needs that, they mean that they need even social services, if there's something that they need from a social service aspect.

We coordinate that with our social services team. We speak and communicate with other healthcare professionals such as nursing, therapy, physical therapy, occupational therapy. Pharmacists, we have to make the appropriate coordination even for when we send medications to the pharmacy to make sure that they know what their copay is before they go there.

And, the medications have been sent to their pharmacy of their preference. We update family members of expectations and what to expect once they get discharged and, take into account what their needs are. So there's a lot of roles that we play other than just the medical care of the patient.

Because we're available 24/7, it studies have actually shown that it reduces mortality rates because we're able to address immediate needs that the patient has while they're in the hospital. If any kind of emergencies happen, we have, we intervene rapidly. We consistently monitor the progress of the patient.

You have one physician that is on seven days in a row that is caring for you, so you have one face. You can call it the captain of the ship that you can, the patients can say, I need to speak to my doctor. So we can address a lot of these issues. Because we're able to address a lot these concerns, patients are not being in the hospital for a prolonged period of times. This way we decrease hospital acquired infections, we improve patient satisfactions. Patients don't want to be in the hospital. They want to go home to their loved ones as quickly as possible. So we have to make sure that we identify what's needed to get the patient out the door promptly. And of course, with all the needs that they have that they needed while they're hospitalized. And in addition to that, because we're so involved in multiple areas, like I said, the chances are you'll probably end up being seen by a hospitalist if you get admitted to the hospital.

Because we are consulted on many cases as well. Because everybody has medical needs. We can identify certain gaps in the system as well. Because we are all over the hospital and a lot of the leadership, they rely on us to be the leaders in hospital medicine and a lot of the hospitals are involved in implementing hospital wide quality improvements, and initiatives that help patients in the long run.

Host: Well, it certainly is so important how you told us about coordination of care, and that's so important for patients to understand. It can be scary and it can be dizzying and quite confusing when you're in the hospital and who's doing what. So thank you for telling us about that and you must be a very busy lady, and I imagine that your patients are feeling very lucky to have you with them because you're so kind and I can hear that compassion in your voice. Thank you so much, doctor for joining us today, and you can learn more about hospitalist physicians by visiting Henry Mayo's free online health library@library.henrymayo.com and typing the word hospitalist in the search box.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review It's Your Health Radio on Apple Podcast, Spotify, iHeart, and Pandora. And for more health tips and updates, you can follow us on your social channels. I'm Melanie Cole.

Thanks so much for joining us today.