Awhile back I wrote about how our small primary care practice was considering giving up rounding on our own inpatients (11/13/12, To Round Or Not To Round)*. At that time it was up in the air… I myself had conflicting emotions about it. Over time, I had gone from being very much in favor of continuing rounding on our own patients, to ambivalent, to pretty pro-giving that up…
And now I am way, way adamant about letting inpatient experts care for our inpatients. As several physician friends commented then (on and offline), inpatient care is becoming more specialized. It’s pretty next to impossible to keep up with both outpatient and inpatient advances, and to be efficient at both areas. It’s probably dangerous to try.
We only have to cover our practice once every few months, for only 7 days at a time… but it’s hard. It starts on a Friday, and I usually block the morning to get to know the inpatients and/or do any admissions/ discharges, then see outpatients in the afternoons: the Friday afternoon urgent visits. Then Saturday and Sunday we have to drive into the city and round, as well as answer pages… The days are unpredictable, and can be pretty long. Monday through Thursday it’s usually rounding in the hospital in the morning, and seeing patients some afternoons, and covering for the docs who are away as well.
My last few stints covering on call, I have struggled with it all: handling the pager calls, the inpatient rounding, and the outpatient load.. and that was with clearing my schedule as much as possible and with using all our available child care to the max (we have alot of help). The last real call I had, in March, at the end of my 7 days on, I was a mess. (Read that post: 3/3/13, I Am A Mean, Nasty Person… On-Call)*.
Meantime, our practice, recognizing that things are getting uncomfortable, if not downright dangerous, is moving towards letting inpatient experts handle our hospital rounding. And so, for my last 2 weeks of call, I have had someone else seeing all the inpatients, doing all the admissions, discharges, and medical consults, while I only hold the pager and answer calls.
And IT IS SO GREAT!
Each week of call has been totally fine and manageable. It’s a totally different experience.
I haven’t had to clear my outpatient schedule, because I don’t have to round. I’ve been able to see all of my own patients and handle all of my own administrative work. It’s not all put on hold. I don’t fall behind. I don’t have to drive into the city on my day off or on the weekend. I just have to answer pages. I’m not as stressed, or distracted, and so I can actually talk to people. It felt more like, offering friendly advice to a neighbor with a question, than being pulled away from the bedside of that sick inpatient with a P.E. . I was much better able to listen.
Best of all, I was able to wake up with my kids, and spend quality family time with them and hubby.
There were a few pages at inopportune moments, like at bathtime and bedtime, but overall it was easier as I had been there all day anyways, and felt well-decompressed.
I am very grateful. I am a total convert. I think there is no going back for me.
I am all-in as an all-outpatient primary care doctor.
*forgive me as I cannot get the links to embed within the text.