Notes on Shadowing a Hospitalist

Summary

I recently shadowed a hospitalist during a 10-hour shift. A hospitalist is a generalist doctor responsible for patients while they are in the hospital. They go through similar training to the doctors you see for your annual check-ups.Unlike ER doctors, who handle immediate crises hour-by-hour, hospitalists manage the day-to-day care of patients with serious but not immediately life-threatening conditions.At any given time, a hospitalist usually manages 8–10 patients, most of whom are new to them. Their job is to quickly gather information from medical records, patient conversations, and test results in order to make diagnoses and eventually discharge patients.Hospitalists function as medical coordinators. They are trained in high-level diagnosis but quick to refer to specialists for specific interventions. In many ways, they act like PMs of the hospital: aligning stakeholders, tracking progress, and ensuring patients are on course. They can order tests such as MRIs but typically leave interpretation and detailed recommendations to specialists (e.g. surgery).The following are a select assortment of notes from my visit:Everyone jokes about death.Everyone including the doctors, nurses, and support staff all joke about death in a way that is jarring to an outsider. This is best interpreted as emotional compartmentalization as a survival mechanism, not callousness. This makes sense, as it enables them to create a barrier between themselves and death. I imagine it’s one of the most effective ways to create a positive work environment while enabling everyone to do their best work without being depressed all day seeing people who are about to die.Verbal communication dominates for up-to-date knowledge transfer, while written notes are often an afterthought.When I first arrived, four surgeons were holding a stand-up meeting at a nearby table. The overnight surgeon recounted the nuances of a surgery she had just performed, while the others tried to listen and skim the patient...