"After this shift, I will have worked 105 hours this week."
"Why is that?" I asked.
"Because unlike the emergency room, where care is transfered easily to guys arriving at the next shift, hospitalists don't have that luxury. We have to stick with our patients once they're ours.
Let's say it's quarter to five. The nocturnist comes on at six. The call comes from the ER and you get a guy that's sick as hell: something like an aortic dissection with crappy renal function that's too sick for surgery. He's never been in our system. No history. No real physical. The family doesn't know his medications. The ER only provides a listing - no doses - I have to call their home and get the list or wait for them to bring in the bottles, review the labs, order a slew more tests. I can't just offload the case to the evening nocturist at six - he's got his own ER admissions he has to see. Meanwhile, I still haven't written notes from seven other patients I've seen that day and have a slew of phone calls and results that I have to review. I can't just offload that to someone else..."
I give this great hospitalist about another month.
Good care takes time. Family social challenges, missing patient information, higher levels of disease severity and anxiety over patient's well-being add to physician stress. As larger number of patients are pushed through the system in shorter periods of time, physician burnout - even in the hospitalists "shift model" - remains a significant problem today.
And to think we're talking about physician pay cuts...