Who Will Be There For You When You’re Dying?
by Robert A. Duke
When I heard specialist physicians, titled hospitalists, were hired to care for hospital inpatients, I asked the hospital for a job description so I might judge their impact on patients, especially at the end of life.
PeaceHealth St. Joseph Medical Center, in Bellingham, Washington, had no job description, so it advised me to research hospitalist employment ads for information. I found this Sound Physicians of Tacoma, Washington, hospitalist employment ad to be typical:
“Awe inspiring natural wonders frame the area with views of Mount Rainier that pop up all around western Washington while the seemingly endless shoreline of the Puget Sound …”
Next, I discovered St. Joseph had no hospitalist job description because its hospitalists refused to cooperate in defining their job; “Too limiting,” they claimed.
About four years later, I attended a January 2018 public meeting with a medical staff panel about compliance issues with end-of-life advance care directives. I learned hospitalists were the medical specialists most likely to make advance directive decisions for end-of-life inpatients. I asked whether there was yet a job description for the responsibilities and duties of a hospitalist, and a panelist said there was, so I asked for a copy.
There was no response after that meeting, so I phoned St. Joseph’s human resources (HR) department to request a hospitalist’s job description, but I was told policy dictated that HR speak only to current or past employees. I drove to the medical center the same day to ask HR staff for a hospitalist job description. None was available, but HR promised to call me.
No one called, but in late March 2018 I met with the hospital’s representative who had claimed in January that a hospitalist’s job description existed. He had learned, he said, there was no job description because hospitalists were hired from a medical staff contracting service, and because hospitalists were contractors they were not St. Joseph employees, thus there was no job description. Unappeased, I asked for a copy of whatever contracting document defined the hospitalist’s job opening to be filled by the medical staffing service. They were working on it, I was told.
Meanwhile, St. Joseph provided a pamphlet, which at least broached the subject to patients:
Who is my St. Joseph Medical Center doctor while I am in the hospital?
Instead of being seen by your primary care physician, patients at PeaceHealth St. Joseph Medical Center are cared for by hospitalists, specialists who work as a team to care for you. During your hospital stay, you may see a few different hospitalists. These specialty-trained physicians rotate shifts so there is a hospitalist on site 24 hours a day. This means there is always someone available to respond to your patient care needs. Your hospitalist will review your relevant medical records (emphasis added) and, depending on your condition, may consult with other specialists. In addition, your primary care physician is notified at the time of your admission and on the day of your discharge. After your hospitalization, your primary care physician will manage your care.
Online I uncovered a formal but unsatisfying definition of a hospitalist by the Society of Hospital Medicine:
Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. (Hospital medicine is far different from outpatient medicine. Duke.)
So I have decided to compose my own description of a hospitalist’s job (as originally suggested to me) using employment ads for hospitalists at simplyhired.com, an aggregator of medical job listings:
Sound Physicians —
Hospitalist Physician Job Located 40 Minutes from Seattle, WA. Take advantage of the investment Sound Physicians makes into developing our hospitalist. Estimated: $220,000 – $300,000 a year.
There is little information about hospitalist’s duties and responsibilities, and as cited from the same ad in the second paragraph above, little more than a pitch about lifestyle and amenities.
I also found this Bellingham, Washington, job ad for a Hospitalist Coordinator for Sound Physicians. It is too lengthy and superficial to present here, but a sample follows:
Sound Physicians —
Estimated: $110,000 – $150,000 BA/BS, 2-3 years experience.
• Order office supplies through the Sound on-line Staples system.
• Consistently role model the highest level of customer service to all Sound Physician customers.
• Forward billing queries, deficient records notices, death certificates requiring signature and other medical records information (emphasis added) to the appropriate physician.
• Support Chief Hospitalist to forward patient care, staff, and other concerns and issues from outside the program to the Regional Chief Medical Officer and Regional Director of Operations.
• Assist hospitalists with making sure they have access to the hospital and Sound computer systems and can get to records to which they will need access (emphasis added).
What is basically an administrative assistant’s job is grossly detailed. The only similarly detailed hospitalist physician employment ad I found was Duke University’s at simplyhired.com. Reproduced here is the part I think is key to the hospitalist role in end-of-life:
Duke University Hospitalist
Direct contact and consultation with patient family members, friends, advocates and others to ensure effective communication of patient status and care plans, and to encourage/support an open visitor-friendly environment within the medical/hospital environment (emphasis added).
So, why all of this fuss about hospitalist job descriptions? At the outset, I said the physician most likely to be attending you at the end of your life is a hospitalist: the medical person overseeing your advance health care directive document and Physician Orders for Life-Sustaining Treatment (POLST) form. Patients and caregivers need to be assured that such duties and responsibilities are spelled out in their hospitalist’s job description. It is imperative to know which medical person is duty-bound to find and access your medical records where your end-of-life choices and directives reside.
Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: firstname.lastname@example.org