Thursday, November 13, 2014

If we were on the Serengeti, we would not be the lions.

I have often viewed hospitalists as "the real doctors" in a hospital, people whose inclination, geographic location, and practice patterns allow them to be fully engaged in creating a partnership between the clinical staff and patients and families.  But this view is not always widely adopted by other medical specialties.  Brad Flansbaum offers this essay about the status--perceived and real--of hospitalist doctors vis-a-vis other practitioners in hospitals.  He titles it, "Do I look like a PGY?"

I engaged my team in a short non-scientific exercise. I asked them to plot their impression of how the world at large, defined broadly, views the worth of various specialties versus how they see them.  They assessed the following four disciplines: intensivists, cardiologists, palliative care docs and hospitalists.

He wryly notes:

Do you notice a pattern? If you don’t, let me make it easy: if we were on the Serengeti, we would not be the lions.  

Beyond the humor, there are serious questions raised about the profession:

Now I could speculate about how any specialist might rate themselves and the biases each would bring to the table. I could also speculate proceduralists and physicians engaged in high tech care have deeply embedded cultural advantages in U.S. medicine—and no matter how we spin the story, docs without toys will always drop to the lower rungs of the ladder.

However, I think our station has much to do with our need to mature as a field, and how the public (and HM) views a young, unassimilated specialty.

Many of us still lack confidence. 

An interesting call to arms of sorts for a group of doctors who, in my mind, have shown that they can be at the forefront of clinical process improvement.  Brad's article suggests that more can come, and should come, from this dedicated group.


nonlocal MD said...

As a pathologist, this post made me laugh knowingly. (A colleague's aunt told her friends he was a mortician.) I wonder if these attitudes will change somewhat as more physicians become hospital-based, as that seems to be another fault line dividing the 'hallowed' from the 'mundane'.
But at heart, it is all about the universal tendency of human societies to establish hierarchies based on all the wrong qualifications. Think of the high school quarterback for instance. Yes, hospitalists, stand up for yourselves - no one else will.

Anonymous said...

As a non-clinician, I wonder how the development and awareness of hospitalists compares with that of emergency department physicians - also a relatively new specialty area.