Welcome to Dr. Matt's Forum:
The current state of Pediatrics:
In recent years we have sadly witnessed a shift in the gatekeeper role of the primary physician as promoter of care. More often than not, hospitalist physicians are entrusted with caring for our patients when they are admitted to the hospital.
These hospitalists, unfortunately, in many cases have not had the priviledge of caring for patients on a continual basis. Hence they frequently cannot get to know your child as well as we do.
We encourage our patients to keep in contact with us as frequently as possible during hospitalizations so that we can communicate with you and the hospitalist staff, ensuring some measure of continuity.
Unfortunately, we have seen increasing conflicts between parents views on how a child is treated, or for example, when a child should be discharged. More frequently than not, the parent has a legitimate grievance by our way of interpreting things. As a result, I am frequently finding myself trying to defend the time tested standards of care I have practiced through four decades.
The "new standards" of care are frequently driven by a hospital's administration to contain costs and make money for the hospital. In some cases they would rather discharge a child and have them re-admitted for the same problem thereby allowing the hospital to start a new billing cycle. Children have been discharged despite my protestations and re-admitted for the very reasons I argued for them not to be discharged in the first place!
While I feel for the hospitals plight, I care for my patients and parents first and foremost. The hospitalists, unfortunately, in many cases are becoming the unwitittng facilitators of the administrators plan to evolve "patient care" into "patient processing." Physicians are the face of medicine, and when something goes wrong because of these new standards of processing, it's the physician and not the administrator who looks bad.
A Note About Urgent Care Centers:
Though at first glance, these establishments may seem like a reasonable alternative, they rarely offer continuity, let alone cost containment. The cost to those patients with HSA's should be clearly evident as urgent care centers frequently charge as much as 40-100%
of what we charge for a visit. More times than not, patients are referred back to us as these entities do not follow up on the "processing" they administer. They are frequently ill at ease
in treating pediatric patients. If you think your needs are "urgent" enough to be seen at one
of these centers, please call us first to see if it would be worthwhile to visit one.