Some HMOs have developed hospital-based physician staffs to manage all inpatients. Although this has been touted as being more efficient, this is generally not the case.
A covering doctor, in the absence of the primary doctor, recently admitted a sixty-three-year-old patient to the hospital for exacerbation of bronchitis with respiratory failure. He noted that the chest x-ray report revealed a granuloma that was calcified; but the radiologist still suggested obtaining a CT scan for evaluation of this calcified mass in the RUL. The primary doctor’s history was incomplete since the patient remembers distinctly that in 1954 she was told she had a TB scar in her right chest. She would have told him the same if he had only asked.
The covering hospital doctor did indeed obtain a CT of the chest that confirmed a calcific density that needed no further confirmation. However, this did add another $600 to the cost of that hospitalization.
As the discussion that hospital-based doctors will be much more efficient in caring for the patient, we have to remain ever vigilant to prevent inferior care being implemented for business efficiency reasons. An office-based doctor who manages a patient will have a number of x-rays, laboratory tests and ECG’s in his private medical record to which he will add in a very cost-conscious manner when his patient enters the hospital. The hospital-based physician, however, must repeat some of this data in a higher-cost center in the name of high quality care, when it is simply duplication of prior care. But it will just make doctors subservient to the hospital-big business complex. Remember the industrial-military complex? It will pale by what is now happening in medicine. We must keep medicine a doctor-patient relationship, not a complex power play.
These messages were written in the years as noted and may be somewhat dated at this time. Please consult your physician or other health care provider.