Wednesday, November 26, 2008

The list of "ists"

Twenty three years ago when I finished my residency and made the decision to go into private practice most obstetricians did the majority of their own patients' deliveries. While there were groups of two, three or four obstetricians, most of the time these guys (and yes, they were mostly men) were on call 24/7 at least where obstetrics was concerned.

Now I am a dinosaur sitting in labor and delivery on a night I am not on call, waiting for a worried patient to deliver. There are "laborist" and the one here tonight would have already done a C-section on my patient. Laborist are OB-Gyn physicians that take call staying in the hospital for 12 to 24 hour shifts being paid both an hourly rate and for the services they provide.

As a matter of fact there is now a list of "ists." Hospitalists see the patients who are admitted to the hospital so that the internist or the family physician can spend the entire day in their offices seeing patients. The intensivists see those patients in the hospital who are in an intensive care unit or (ICU) setting. Intensivist have specialized training in cardiology or pulmonary medicine since the heart and the lungs are critical organs to care for when the patient is that ill. Neonatologist see very sick infants caring for them in the hospital when they need care the pediatricians are not specialized enough to provide.

Focusing on this list takes me back to my original post, the local medical doctor, or LMD as we use to call them when I was in medical school. The LMD was someone who knew you well. He not only knew your lab values and what the CT scan shows but who your spouse or significant other is and maybe even the fact that you have both. The LMD is not a technician, working a shift, providing a product called "health care". She is someone who cares about your health.

What could be more important when you are ill enough (and it takes much more to make you that sick today) to be in the hospital? The rational however is that this "ists", with their special skills and twenty-four hour attention to hospital care, will save money managing care and getting you out of the hospital sooner. I am yet to be convinced but I am not here to argue the point.

And by the way, my patient just delivered a health eight pound little girl without a C-section. That is something we can all feel very happy about, even at 3 o'clock in the morning.
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