What if we are all they have?

I recently attended a CME conference at Johns Hopkins University titled “Infectious Diseases Update for Primary Care and Hospital Medicine.” As one would assume, some things were highly germane to my practice as a hospitalist, while others were, well, not relevant at all.

Don’t get me wrong, the conference was excellent and very thought provoking. It not only taught me clinically useful information, it challenged me to do more than I am used to doing for my patients; thus, I pass this challenge along to you.

One expert presented a case of an otherwise healthy patient who was found to have mildly elevated liver function tests on routine lab work done for life insurance purposes. His ALT and AST were 73 and 36, respectively, numbers that many of us would simply defer to the primary care provider to follow. But what if there is no primary care doctor? What if we are all they have?

Upon further evaluation, this patient was found to have hepatitis C. A more detailed history revealed that he had injected drugs with friends a few times over 20 years ago. The conference presenter shared statistics showing there are 2.7 million to 5 million people living with chronic HCV in America, and an estimated 45% to 60% of them are unaware of their disease – a disease that responds so well to treatment that simply screening baby boomers has the potential to prevent over 120,000 HCV-related deaths! It’s mind boggling to imagine how many people of all ages will die from this disease alone, completely oblivious to its existence.

Many people have obtained health insurance as a direct result of the Affordable Care Act, yet there are still many Americans who remain uninsured. When they are hospitalized for an acute illness, it may be the only encounter they have had with a medical professional in years. So, I ask the question again: What if we are all they have?

We can design all the elaborate hand-offs, discharge summaries, and patient instruction forms we want, but what if patients are unable to actually act on our “easy-to-understand” recommendations? Many of our patients will, out of embarrassment, nod their heads in agreement when we stress the extreme importance of following up with a primary care doctor and getting their prescriptions filled, knowing all the while that they simply don’t have the means to do so. I don’t think I will ever forget how out of touch I felt after giving a patient my spiel about taking his medication as prescribed to decrease his risk of a heart attack. He looked straight into my eyes and frankly, yet ever so respectively said, “Dr. Hester, I can either buy my medicine or I can eat.”

Sometimes it’s just that simple.

We all feel the urgency to provide high-quality care while keeping that care cost effective and time efficient, but hospitalists have a unique opportunity to not only serve our patients’ acute needs when they present via EMS to the ED, but to protect them from unforeseen catastrophes in the future. An extra (needed) test here and there, a little more time spent counseling on lifestyle changes, a few more minutes spent trying to help coordinate affordable (or free) follow-up care can all pay big dividends, and you may never have to see those patients in the hospital again. Isn’t that the goal?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

I recently attended a CME conference at Johns Hopkins University titled “Infectious Diseases Update for Primary Care and Hospital Medicine.” As one would assume, some things were highly germane to my practice as a hospitalist, while others were, well, not relevant at all.

Don’t get me wrong, the conference was excellent and very thought provoking. It not only taught me clinically useful information, it challenged me to do more than I am used to doing for my patients; thus, I pass this challenge along to you.

One expert presented a case of an otherwise healthy patient who was found to have mildly elevated liver function tests on routine lab work done for life insurance purposes. His ALT and AST were 73 and 36, respectively, numbers that many of us would simply defer to the primary care provider to follow. But what if there is no primary care doctor? What if we are all they have?

Upon further evaluation, this patient was found to have hepatitis C. A more detailed history revealed that he had injected drugs with friends a few times over 20 years ago. The conference presenter shared statistics showing there are 2.7 million to 5 million people living with chronic HCV in America, and an estimated 45% to 60% of them are unaware of their disease – a disease that responds so well to treatment that simply screening baby boomers has the potential to prevent over 120,000 HCV-related deaths! It’s mind boggling to imagine how many people of all ages will die from this disease alone, completely oblivious to its existence.

Many people have obtained health insurance as a direct result of the Affordable Care Act, yet there are still many Americans who remain uninsured. When they are hospitalized for an acute illness, it may be the only encounter they have had with a medical professional in years. So, I ask the question again: What if we are all they have?

We can design all the elaborate hand-offs, discharge summaries, and patient instruction forms we want, but what if patients are unable to actually act on our “easy-to-understand” recommendations? Many of our patients will, out of embarrassment, nod their heads in agreement when we stress the extreme importance of following up with a primary care doctor and getting their prescriptions filled, knowing all the while that they simply don’t have the means to do so. I don’t think I will ever forget how out of touch I felt after giving a patient my spiel about taking his medication as prescribed to decrease his risk of a heart attack. He looked straight into my eyes and frankly, yet ever so respectively said, “Dr. Hester, I can either buy my medicine or I can eat.”

Sometimes it’s just that simple.

We all feel the urgency to provide high-quality care while keeping that care cost effective and time efficient, but hospitalists have a unique opportunity to not only serve our patients’ acute needs when they present via EMS to the ED, but to protect them from unforeseen catastrophes in the future. An extra (needed) test here and there, a little more time spent counseling on lifestyle changes, a few more minutes spent trying to help coordinate affordable (or free) follow-up care can all pay big dividends, and you may never have to see those patients in the hospital again. Isn’t that the goal?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

I recently attended a CME conference at Johns Hopkins University titled “Infectious Diseases Update for Primary Care and Hospital Medicine.” As one would assume, some things were highly germane to my practice as a hospitalist, while others were, well, not relevant at all.

Don’t get me wrong, the conference was excellent and very thought provoking. It not only taught me clinically useful information, it challenged me to do more than I am used to doing for my patients; thus, I pass this challenge along to you.

One expert presented a case of an otherwise healthy patient who was found to have mildly elevated liver function tests on routine lab work done for life insurance purposes. His ALT and AST were 73 and 36, respectively, numbers that many of us would simply defer to the primary care provider to follow. But what if there is no primary care doctor? What if we are all they have?

Upon further evaluation, this patient was found to have hepatitis C. A more detailed history revealed that he had injected drugs with friends a few times over 20 years ago. The conference presenter shared statistics showing there are 2.7 million to 5 million people living with chronic HCV in America, and an estimated 45% to 60% of them are unaware of their disease – a disease that responds so well to treatment that simply screening baby boomers has the potential to prevent over 120,000 HCV-related deaths! It’s mind boggling to imagine how many people of all ages will die from this disease alone, completely oblivious to its existence.

Many people have obtained health insurance as a direct result of the Affordable Care Act, yet there are still many Americans who remain uninsured. When they are hospitalized for an acute illness, it may be the only encounter they have had with a medical professional in years. So, I ask the question again: What if we are all they have?

We can design all the elaborate hand-offs, discharge summaries, and patient instruction forms we want, but what if patients are unable to actually act on our “easy-to-understand” recommendations? Many of our patients will, out of embarrassment, nod their heads in agreement when we stress the extreme importance of following up with a primary care doctor and getting their prescriptions filled, knowing all the while that they simply don’t have the means to do so. I don’t think I will ever forget how out of touch I felt after giving a patient my spiel about taking his medication as prescribed to decrease his risk of a heart attack. He looked straight into my eyes and frankly, yet ever so respectively said, “Dr. Hester, I can either buy my medicine or I can eat.”

Sometimes it’s just that simple.

We all feel the urgency to provide high-quality care while keeping that care cost effective and time efficient, but hospitalists have a unique opportunity to not only serve our patients’ acute needs when they present via EMS to the ED, but to protect them from unforeseen catastrophes in the future. An extra (needed) test here and there, a little more time spent counseling on lifestyle changes, a few more minutes spent trying to help coordinate affordable (or free) follow-up care can all pay big dividends, and you may never have to see those patients in the hospital again. Isn’t that the goal?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.