Monday, September 24, 2012

Ward Physicians, Hospitalists and the iPatient

There has been a change in the age mix of ward attending physicians.  Medical care is now subject to greater demands on supervision, documentation, efficiency, and, for residents, duty hour restrictions. As a result, supervising physicians now are younger, general internists or hospitalists, and more directly engaged in patient care. The focus is patient throughput. 

The days of subspecialty oversight, by older physicians, with an academic perspective are largely over. The old model allowed for greater resident autonomy in patient care, the new model favors supervision and efficiency.

Here is a commentary, by Robert Wachter and Abraham Verghese, published in JAMA. The authors call for a new balance between resident supervisions and autonomy, one that still allows for more traditional teaching of residents and students, particularly at the bedside.

At risk in the current model, is the loss meaningful and transformational human contact with the patient, in favor greater of efficiency and of managing the virtual patient in the electronic medical record, also dubbed the "iPatient".

Here are my thoughts.  I believe that greater supervision and work hour restriction of residents is likely a good thing although there are no robust data to suggest that this results in improved patient and educational outcomes. There is also no data to suggest that the new model is detrimental to patients and learners. As we are not likely to turn back the clock, the onus is on us to ensure that there is no erosion of the human touch in medicine. Academic, supervising physicians should learn to balance efficiency, work rounds with select bedside teaching rounds, perhaps to highlight and review interesting cases, patient stories and exam findings. 

The task is not simple and, at times, inconvenient, but medical training was never meant to be easy. 

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