Who will take care of me in the hospital?

Patients admitted to the hospital have many concerns.  Paramount among them is, “Will my primary care doctor take care of me while I am in the hospital?”  If not, who will?       The answer is that when you are admitted to the hospital you will be under the care of a hospitalist – not your primary care doctor.  Let’s find out who these special physicians are and exactly what they do.  

Who: A hospitalist is a doctor who only works in the hospital.  A hospitalist has training in a medical specialty, for example, internal medicine, family practice, and pediatrics. 

When: Hospitalists coordinate patient care in the hospital.  In the same way surgeons and obstetricians are the experts on operations and babies, hospitalists are the experts on medical issues within the hospital setting.

Why: The need for in-patient physicians--hospitalists-- arose as changes in medicine made it increasingly difficult for primary care doctors to take time out of their hectic schedules to travel to the hospital and care for their patients. Additionally, hospital care is more complex, thereby creating the need for a physician dedicated to the care of “inpatients”.  Studies have shown that hospitalists provide timely, high quality care.  To be sure in a perfect world, your personal doctor would follow you wherever you go, irrespective of location – hospital or community. However it’s just not possible, given the complexities of medical treatments.  There must be an on-site physician to make the right decisions at the right time – which is whenever you enter the hospital, night or day. 

What: Among many other duties, a hospitalist talks to specialists, orders tests, admits and discharges patients, and works with myriad of healthcare workers including, but not limited to: nurses, social workers, and pharmacists.  The primary role of the hospitalist is to provide the best evidence-based care while simultaneously acting as the patient-advocate and guiding families through the intricate web of healthcare.

Your primary care physician (PCP) may not be aware that you are in the hospital.  Oftentimes it becomes impossible for the hospital to alert the PCP when patients are admitted. When you see your PCP at the post-hospital appointment, let your doctor know you were hospitalized and if possible request a copy of hospital medical records prior to office visit.

Hopefully, you won’t ever experience first-hand what a hospitalist does.  However, if you do, you’ll already know a lot about this burgeoning field of medicine. Be well. 

High Blood Pressure

A stroke is a devastating illness, and can be the direct consequence of hypertension. 

Imagine never again experiencing the simple pleasures of life:

·      Walking barefoot along the beach.

·      Licking an ice cream cone.

·      Swimming laps in the pool on a sunny day.

·      Talking trash while playing Bid whist.

·      Catching a ball with the grandchildren.

·      Baking a favorite pie.

·      Reading a novel.

·      Solving, at least attempt to, the Sunday crossword puzzle. 

·      Buttoning a shirt.

·      Pulling own pants up.

A seemingly insignificant, yet deliberate action can spark a cascade of terrible, life-altering events.

One-third of American adults have high blood pressure - hypertension.   Hypertension is blood pressure greater than 140/90.  If you consume more than 1 teaspoon salt each day, are obese, don’t exercise, drink in excess of 2 alcoholic drinks daily, and/or have a mother or father with hypertension you are at risk.  Twenty-five to thirty million Americans with hypertension are on anti-hypertensive medications but still have blood pressure greater than goal (140/90).  That’s dangerous!  High blood pressure is a silent killer.  You feel fine even as damaging changes are happening to your body.  Uncontrolled hypertension causes strokes, heart attacks, kidney failure, and impotence.  Stroke patients can be left with the inability to talk, walk, or eat without assistance.  Hypertension also can cause heart disease that could lead to impotence.  Here’s one more one more sobering fact: high blood pressure renders the kidneys nonfunctional and urine is no longer produced – leaving waste materials in the body without a way to exit.   This necessitates hemodialysis (dialysis).  Dialysis is a 3-4 hour, three times a week, life-preserving treatment, only reversible with a kidney transplant.

I have heard every excuse in the book for not getting-on or staying-on anti-hypertensive medications.  “I ran out of medicine”.  “The pills made me feel funny”.   “My blood pressure is only high when I am at the doctor”.  “I am using a home remedy”.  None of these excuses will make much sense to you or your family if you land in the hospital with a stroke or heart attack.  Taking anti-hypertensive medicine should be like brushing your teeth; you do it everyday without thinking about it.  And, if you have the option of putting your medications on automatic refill – do it, so that you won’t run out.  But if you run out of medications while away or after your doctor’s office hours, find a retail health care clinic that will do a one-time refill.  Do not just stop taking your medications!  Remember to talk to your doctor if you experience side effects.  Once on medications, check your blood pressure weekly at the supermarket, pharmacy, or local fire station.  Write down the numbers and take those to your next doctor’s appointment.

The choice is yours – stroke, heart attack, dialysis, or impotence?  Or take your medicine!  It should be a pretty easy decision.  Be well.