By: Donnie Byers
Jihad Arteh, M.D., completed a residency in Internal Medicine but deals with almost every ailment imaginable at his job. One minute, he could be sitting with a heart attack patient or accident victim. Then, he could see a struggling diabetic or gunshot wound victim the next.
He does it throughout the halls of Cape Fear Valley Medical Center and not a medical office. The only office he has is his next patient’s room or the nearest computer terminal. But that’s just fine with the East African-born physician.
“I didn’t want to focus on just one area of specialty,” he said. “Hospital medicine has become so complex today, so there’s a need for what I do.”
Dr. Arteh is a hospitalist: a physician who specializes in treating acutely ill or injured patients within a hospital setting. It’s a relatively new medical field, but rapidly growing in the U.S. An estimated 30,000 hospitalists are currently in practice, up 50 percent from a few years ago.
The term “hospitalist” was first mentioned in a 1996 New England Journal of Medicine article, describing the emerging practice of hospital medicine. Like emergency medicine, it specializes around a facility rather than a specific organ or a patient’s age. It’s currently an American phenomenon, but gaining traction in Canada.
Most hospitalists work in larger hospitals and medical centers, but smaller community hospitals are starting to embrace the field. These hospital specialists are the healthcare industry’s answer to declining availability of family doctors.
It used to be when a patient was admitted to the hospital, their family doctor would still direct their care. The doctor would write up prescriptions or leave specific care instructions during early morning hospital rounds, before scurrying back to the office to see other patients.
If something came up during the day or night, the doctors would be called so they could give orders or come back to the hospital. But the days of doctors accepting house calls and making back-and-forth trips to the hospital are all but over.
Today, only patients with serious illness or injuries are admitted to hospitals. This allows family physicians to focus on their office practice and keeping patients well and out of the hospital. Hospitalists take care of the rest.
Patients admitted to Cape Fear Valley are seen by one of 50 hospitalists on staff. Each hospitalist is assigned to a certain hospital floor or unit. Some are based out of Cape Fear Valley’s Emergency Department. These hospitalists can admit patients who don’t have a regular doctor, or if the patient’s personal physician contracts with Cape Fear Valley Hospitalist Group.
Dr. Arteh is one of two clinical program directors with Cape Fear Valley Hospitalist Group. It’s his job to assign patient caseloads to each hospitalist every morning. If a hospitalist needs help, the clinical program director springs into action. It’s called “floater” duty, and Dr. Arteh does his tours like an old pro already.
On a recent Thursday morning, Dr. Arteh was helping with patients on every floor at Cape Fear Valley Medical Center. His routine includes taking a minute to talk to the attending nurse or nurse supervisor about his next patient before entering the patient’s room.
Sporting a warm smile, and an even warmer bedside manner, the doctor pulls up a chair, crosses his legs and clasps his hands over his knees, before leaning over to ask how the patient is doing.
Each patient describes his or her pain level on a 1-to-10 scale. After a few questions, Dr. Arteh does a hands-on examination before giving his recommendations. It could be an order for additional tests, changes in treatment or medication, or discharge from the hospital.
It’s the same routine all the hospitalists at Cape Fear Valley perform twice a day; once in the early morning, and then again around 3 p.m.
Michael Zappa, M.D., is Cape Fear Valley’s Associate Chief Medical Officer for the Emergency Department and Acute Care. He says family doctors and primary care physicians are lucky if they can do one round a day because of their busy schedules.
“Our hospitalists are dedicated to just taking care of the patient,” he said. “They don’t have the added distraction of having to run a private practice on their own.”
Cape Fear Valley has been using hospitalists for many years and recently began a push to hire more. Thirty have been hired in the past year, with more expected.
Dr. Zappa says the rising number of admitted patients at Cape Fear Valley makes it necessary. These patients often stay for shorter periods. Many are often discharged when their condition is stable but not fully healed.
This is done because it is better for patients to recover at home, away from antibiotic-resistant bacteria that may live in the hospital. As a result, Dr. Zappa says patients need the best care possible while still in the hospital.
George Shalhoub, M.D., is the Administrative Program Director for Cape Fear Valley Hospitalist Group. He says hospitalists simply have more time, as well as expertise, in caring for complicated hospitalized patients.
“We’re all one team,” Dr. Shalhoub said. “We’re focused on providing the best care possible and getting the patient home as soon as possible, so they can ultimately be seen again by their primary care provider.”