Bill Klaproth: (Host):  Do you know what a hospitalist is and what that person does?  Here to tell us more is Dr. James Principe, a hospitalist for Tidelands Health. Dr. Principe, thanks so much for being on with us today. Tell us what is a hospitalist?  

Dr. James Principe (Guest):  A hospitalist is basically a physician who specializes in hospital medicine. The Society for Hospital Medicine just celebrated its 20th anniversary this year. In fact, they are calling this “The Year of the Hospitalist”. Basically, when this whole movement started out 20 years ago, maybe a little better than 20 years ago, we were just doctors taking care of other doctors’ patients in the hospital; or, when patients showed up at the hospital and didn’t have a physician on staff, we took care of them. It’s really transformed into a specialty of sorts. Medicine is complicated and gets more complicated by the day as new treatments are discovered. So, it’s getting harder to do everything. Basically, what we do is we specialize in taking care of very sick people who come to the hospital. The way it works is the emergency room physician assesses the patient when they get to the hospital. Most of our admissions come to the emergency room although we do admit some folks directly from physician offices, most of our admissions come through the hospital emergency room. The emergency room will assess the patient. If they deem that the patient is ill enough and requires inpatient hospital services, they’ll call the hospitalist and the hospitalist will come downstairs and evaluate the patient and take care of them from there. We’ll also coordinate the care in the hospital with other subspecialists, whether you need a cardiologist, pulmonary specialist, or what have you. We will help coordinate care and a great deal of what we do, too, is discharge planning and trying to make sure that at discharge, you stay healthy and get back to see your primary care provider. It’s crucial for us to have good communication with our primary care providers so that we can let them know what we’ve done with their folks in the hospital and let them take it after discharge.

Bill:  It sounds like it’s all-encompassing. What is the overall benefit of this?  Most people that come into the hospital have a primary care physician. Why are they seeing the hospitalist, then?

Dr. Principe:  It’s funny, I’ve got a different perspective because I did primary care for about 15 years before I became a hospitalist and I did traditional primary care, so I saw my patients in the office and I took care of them in the hospital when they went there. As things got more complicated, and Tidelands Health is, of course, a two-hospital system, it’s getting more and more difficult for physicians to do it all--to see their patients in the office in a timely fashion and then be able to follow them in a hospital. Forget about seeing them in two hospitals. It’s almost impossible. You can’t go to two hospitals 22 miles apart every day and then get back to your office and see patients. Part of it’s a convenience thing. Part of it’s a complexity thing. Our primary care docs in the office are expert in taking care of primary care problems in the office. They’re managing chronic diseases in the office. They’re doing a lot of preventive care. They’re expert in those things. We help them out by allowing them to spend more time in the office so they can provide those types of services to their patients. When their patients end up in the hospital, they kind of hand over the care to us. We do our specialty thing in a hospital and then we get them back to them to continue with their expert primary care services.

Bill:  So, you’re basically replacing the primary care physician while that patient is in the hospital. So, a patient then wouldn’t have any communication with their primary care physician?  Sounds like they certainly wouldn’t see them.  You’re going to see them but you’re coordinating back and forth with the primary care physician?

Dr. Principe:  Yes. When a primary care physician’s patient gets admitted, we send them a notice right off that bat that their patient has been admitted to the hospital. They can provide us with information, if need be about what’s been transpiring with them in the office setting. So, yes, there’s a lot of communication there. One thing that benefits us is the electronic medical records. All of our primary care providers have access to our electronic medical records themselves so they can tap right in there, see what’s going on day by day.  They’re all on courtesy staff, so some of them actually come by and visit their patients still just to sort of check up on them. For the most part, communication is enhanced by our electronic medical records.

Bill:  Since you’re always there on site, I could see one benefit to this. I have an elderly father and, in fact, a couple of week ago, I was in the hospital. We were waiting and waiting for the primary care physician to come because he had his responsibilities in the office and only made certain trips to the hospital at certain times. It sounds like the hospitalist is always there and you’re able to provide a lot quicker feedback and updating of the patient’s condition to the family and to the patient.

Dr. Principe:  That’s absolutely true. We’re there 24 hours a day, 7 days a week. There’s always a hospitalist responsible for each patient that we have. Yes, in one way, we hope to potentially cut your length of stay in the hospital so you’re not having to stay in the hospital longer than you need to be. We get to the patient quicker. When I was in primary care and doing traditional hospital and office practice, I’d be called at my office – the patient is in the emergency room. I may be called at my home – the patient is in the emergency room. I give orders to the nurse, they put the patient in the hospital and it may be hours before I get myself freed up to go over to the hospital to see that patient. It’s different as a hospitalist. A hospitalist, really, generally sees the patient within an hour of being admitted. You get the workup and the evaluations started quicker. That kind of cuts your time in the hospital. That’s true. Then, as far as the communication part, that’s very important also. We’re there. We work 12-hour shifts so our day shift doctors that are primarily caring for the patient daily, they are there for 12 hours from 7am to 7pm, so we’re available to talk with family members, really, at their convenience not at the doctor’s convenience. We’re trying to make things more patient centered. We’ve also started a system where we, on several of our teams, we’re doing what’s called a “structured inter-disciplinary bedside round”. What that basically means is, every day at a designated time, we tell families and patients that we’re going to be there at the bedside as a team with the primary nurse, the charge nurse, the case manager, the pharmacist, and we’ll be able to--it’s kind of a touch point. We are able to kind of go over things briefly for a couple of moments to make sure we’re all on the same page, answer questions and move on. That’s another very important communication piece and it’s a daily thing we try to do. I think it’s really enhanced the communication among family members and provided really what needs to be patient-centered care.

Bill:  This sounds like a huge benefit and, like I said, just having gone through this, everything you say there makes total sense to me. Having somebody on site, somebody there and somebody there throughout the day to be with the patient throughout the multiple tests that usually have to be given. I love this idea. Let me ask you this, though, do you get some kickback from patients who say, “I’ve seen my primary care physician for 20 straight years. Where is he or she?  Why am I dealing with you now?”  How do you deal in those situations?

Dr. Principe:  We’ve had the hospitalist service. We are now in our 10th year with Tidelands Health as a hospitalist group. Initially, early on, yes, there were questions about that. We had to do some public relations. We had pamphlets. We tried to explain in our pamphlet who we were and what we did. We gave a little brief synopsis of each of us. We tried to disburse those into the primary care offices so that patients wouldn’t be taken by surprise and they kind of had a head’s up if they ended up in the hospital they may be seeing a different doctor. In reality, many primary care groups are more than one doctor. Even in my own practice back in the day when I was doing primary care, I didn’t always see my patient in the hospital. I mean, basically, your partner sometimes would share coverage and what have you. It really was already you weren’t always seeing your primary care doctor all the time. But, you’re right. We did have to do some public relations about that and explain that to people. It’s much more accepted now because I think the last numbers I saw through the Society for Hospital Medicine, it’s at least 60% of hospitals that have hospitalist services now. It’s probably more.  That number may be a couple of years old. I think the public is getting more in tune to it and what have you. It’s very critical for me to tell patients when I first see them, I come in and I’ll say, “I’m Dr. Principe. I’m the Director of the Hospitalist Group. Your doctor is Dr. Jones and I’m going to be sure I keep him in the loop. I’m going to let him know. I’m going to send him a note and let him know that you’re here. We’ll be communicating and then when you go back to see him, he’ll have the information he needs.”  I always explain to them, too, “Look, your doctor is your primary doctor. He knows you best so we do some things here. We may change a couple things, we may not. It’s imperative you get back to see your primary care provider, generally within a week of discharge, to be sure that you’re best taken care of.”  We try to let them know from the get go that we’re going to have communication and we’re sort of an extension of the primary care doc in the hospital. I look at myself as a primary care doc in the hospital. I’m an extension of the primary care physician.

Bill:  Communication is the key and I can see any patient if it gets explained to them that way, where they would fully understand it and feel comforted in it. “Okay, my primary care physician is in the loop. I understand this let’s go.”  How you explained it there is excellent and, again, communication is the key for that. Dr. Principe, let me ask you this as well. If any of us are admitted to the hospital and are being treated by a hospitalist, is there any additional information we should know?

Dr. Principe:  Obviously, you want to know who you doctor is. That’s kind of a challenge of a hospitalist – that we’re strangers. Basically, they didn’t really chose us, right?  So, when I was in primary care, I was chosen as the patient’s doctor. They kind of knew a little bit about me. It’s important for all of us. I make sure I give them my card. I let them know where I’m from. I actually grew up in New Jersey. I tell them where I went to school, where I did my residency. I tell them a little bit about myself so that they kind of get an idea of who this person is that has come in to take care of me. That’s critical. You’ve got to make people feel at ease and understand that they’re in good hands and we’re professionals. I also try to tell them, too, and one way to kind of make them a little more comfortable with the whole situation is that by virtue of us being in the hospital and helping their primary care doctor out, their primary care doctor can serve them better in the office. Many of our primary care doctors now have expanded their hours. They have weekend hours. They weren’t able to do that before when they were trying to juggle office and hospital work together.

Bill:  This sounds like a huge benefit all the way around, for sure. Dr. Principe, thank you so much for your time today. Lastly, why should someone choose Tidelands Health for their healthcare needs?

Dr. Principe:  I think that folks maybe don’t realize that Tidelands Health is probably the largest healthcare delivery system in the low country. Basically, we’ve covered all the bases for the most part from outpatient medical treatment, from physical therapy, health point, health and fitness, hospital medicine. It’s really kind of one-stop shopping. We’ve got great expertise in taking care of most any medical problem that you could have. It’s a family caring for family.

Bill:  That sounds great. Dr. Principe, thank you so much for your time today and explaining to us what a hospitalist is. For more information about Tidelands Health physicians, services and facilities visit tidelandshealth.org. That’s tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.