Henry Chambers, MD – Hospitalist
44 years old; Married, two children; works in seven-day stretches, typically 7:00 am – 7:00 pm
Henry is a hospitalist covering the hospital census with three other physicians and two mid-levels. On the first day of his shift, he assumes care for 15–20 patients and needs to quickly familiarize himself with their conditions and treatment plans. Each morning, he reviews his patient list and determines if anything happened with his patients overnight before rounding on his patients each day until they are discharged.
In his role as a hospitalist, Henry is responsible for coordinating the care of hospital patients with specialists, as well as communicating the plan of care with patients and family members. He is also responsible for documenting patient visits using templates in the EHR; placing orders and prescribing medications at discharge; reviewing incoming test results to determine a patient’s care plan; assessing when a specialist is needed and ordering those referrals/consultations; and recording billing information (as needed) to support the hospital’s billing department.
Henry is a good communicator with hospital staff and with patients and families. Despite the long hours and many responsibilities of his job, he feels that shift work as a hospitalist helps him maintain his work-life balance.
Henry is familiar and comfortable with desktop devices, and uses a smartphone and iPad regularly. He also uses voice recognition to dictate reports/notes at work.
“I need a way to easily glean the patient's story as I come on shift.”
“I can't find any info on what this patient has had done to him in the past.”
“I enjoy working with new patients and learning about new medical cases, but I wish I worked in a slower volume practice so I could learn more.”
“I wish I could see how my patient is feeling post-release.”
“Why can't the EHR updates be as intuitive as my iPhone updates?”
- Provide high-quality hospital care, as aligned with the latest guideline standards, while keeping cost of care and length of stay low.
- Avoid preventable errors, accidents and patient harm.
- Maintain high patient satisfaction by helping patients understand their illness/injury and achieve the medical goals set for them during their hospital stay.
- Intervene with critical patients early and rapidly.
- Recognize end of life. Provide comfort care when applicable and discuss situations when care is doing more harm than good for the patient.
- Complete required paperwork and electronic documentation more efficiently so that more time can be spent interacting with patients on a personal level.
- Work better with the hospital staff and clinical care team, e.g., increase their trust and confidence in medical decision making and follow-up.
- Ensure that daily clinical documentation is contributing to the hospital’s ability to meet annual quality metrics.
- Better manage feeling overwhelmed by using time to complete paperwork to decompress and reset.
- Earn money to support children and family’s lifestyle and pay off large education loans.
- Move into a hospital leadership position and reduce clinical responsibilities so work hours are more regular.
- Improve thoroughness of charting and documentation to make my colleagues happy.
- Continue to research and become educated on certain patient conditions.
- Better communicate with colleagues in effort to share the patient load more effectively.
- Help IT reorganize the electronic chart to locate information more efficiently.
Typical Problems Faced on the Job
- Fatigue, both from repetitive, monotonous tasks and frequent need to respond to multiple urgent matters at the same time.
Not much time is allowed per patient, so the ability to quickly review all the necessary data is critical. However, the electronic chart is not always up-to-date, which is a big deal when trying to get up-to-speed on patient information. For example:
- Patient’s summary is crowded with a lot of data (“information overload”), so it is not easy to identify the trouble areas that should be prioritized during the visit.
- Not able to confirm the patient’s past medical history (e.g., procedures and diagnoses from the last three years), which lowers confidence when making treatment decisions.
- No efficient means of communication with other providers. Sometimes feel unable to treat patients effectively while waiting for a consultant or specialist to follow up.
- Entering information into the EHR can distract from interactions with patients, negatively impacting patient satisfaction.
- When new patients are admitted, the appropriate clinical staff are not always notified in a timely manner.
- EHR documentation often must be completed at home because there is not time to finish at work.