Page 41 - issue
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Doctors 37
all over the country. Richard Gunderman, M.D., Ph.D., writing
recently in The New England Journal of Medicine, says
“Increasing reliance on hospitalists entails a number of risks
and costs for everyone involved in the health care system –
most critically, for the patients that system is meant to serve.
As the number of physicians caring for a patient increases,
the depth of the relationship between patient and physician
tends to diminish – a phenomenon of particular concern to
those who regard the patient–physician relationship as the
core of good medical care.
“The true core of good medicine is not an institution but
a relationship — a relationship between two human beings.
And the better those two human beings know one another,
the greater the potential that their relationship will prove
effective and fulfilling for both.”
Dr. Julian Jakobovits, another long-time community physi-
cian, concurs and adds, “For our community, in particular,
not having your own doctor is very disorientating for a
patient at the time they need it the most, especially with com-
plicated cases. For example, if a patient is in Intensive Care,
oftentimes it is not only medical decisions but halachic deci-
sions that need to be made.”
In such cases, our community doctors, particularly ones
with whom we share a culture, can be much more sensitive
to these issues. Dr. Jakobovits said that he has been in the
beginnings of some discussions with the hospital about what
community doctors can do to “hold the hands of patients”
while they are there. He says the hospital recognizes that
there is a difficulty, but there is no solution at this point.
It Comes Down to Money
So why are community doctors no longer visiting the hospi-
tals when their patients have been admitted, including Sinai?
Dr. Cooper says there are many reasons for this, including
financial and political ones.
When a patient is admitted to the hospital, the fee, deter-
mined by the Health Services Cost Review Commission
(HSCRC) that the hospital can bill for is not based on the
length of stay. It is based on factors such as age and diagno-
sis. This makes it more cost effective to get the patient in and
out of the hospital as quickly as possible. The less amount of
time the patient is in the hospital, the greater chance for prof-
it on the hospital’s part. The hospitalist, along with other
medical personnel, is a salaried employee of the hospital.
When the hospitalist is in charge of the patient, the hospital
receives the payment.
Disincentives to Care
Under the old system, community doctors visited patients
during their hospitalization, and the doctor’s practice would
receive the fees. As Dr. Jakobovits explained, under that sys-
tem, he could see his patients once a day, order any neces-
sary tests, and be in touch with the hospital team, which
u 410 358 8509 u
all over the country. Richard Gunderman, M.D., Ph.D., writing
recently in The New England Journal of Medicine, says
“Increasing reliance on hospitalists entails a number of risks
and costs for everyone involved in the health care system –
most critically, for the patients that system is meant to serve.
As the number of physicians caring for a patient increases,
the depth of the relationship between patient and physician
tends to diminish – a phenomenon of particular concern to
those who regard the patient–physician relationship as the
core of good medical care.
“The true core of good medicine is not an institution but
a relationship — a relationship between two human beings.
And the better those two human beings know one another,
the greater the potential that their relationship will prove
effective and fulfilling for both.”
Dr. Julian Jakobovits, another long-time community physi-
cian, concurs and adds, “For our community, in particular,
not having your own doctor is very disorientating for a
patient at the time they need it the most, especially with com-
plicated cases. For example, if a patient is in Intensive Care,
oftentimes it is not only medical decisions but halachic deci-
sions that need to be made.”
In such cases, our community doctors, particularly ones
with whom we share a culture, can be much more sensitive
to these issues. Dr. Jakobovits said that he has been in the
beginnings of some discussions with the hospital about what
community doctors can do to “hold the hands of patients”
while they are there. He says the hospital recognizes that
there is a difficulty, but there is no solution at this point.
It Comes Down to Money
So why are community doctors no longer visiting the hospi-
tals when their patients have been admitted, including Sinai?
Dr. Cooper says there are many reasons for this, including
financial and political ones.
When a patient is admitted to the hospital, the fee, deter-
mined by the Health Services Cost Review Commission
(HSCRC) that the hospital can bill for is not based on the
length of stay. It is based on factors such as age and diagno-
sis. This makes it more cost effective to get the patient in and
out of the hospital as quickly as possible. The less amount of
time the patient is in the hospital, the greater chance for prof-
it on the hospital’s part. The hospitalist, along with other
medical personnel, is a salaried employee of the hospital.
When the hospitalist is in charge of the patient, the hospital
receives the payment.
Disincentives to Care
Under the old system, community doctors visited patients
during their hospitalization, and the doctor’s practice would
receive the fees. As Dr. Jakobovits explained, under that sys-
tem, he could see his patients once a day, order any neces-
sary tests, and be in touch with the hospital team, which
u 410 358 8509 u
