Sad Days Ahead?
After reading “Letters” in the last issue, I am writing to share some thoughts about house staff training and “patient ownership.”
As I reflect on my own house staff training at Johns Hopkins many years ago, it seems to me that we had a different attitude about patient care and continuity of care than that which is currently the “standard way” of training medical house staff in 2014. The Osler house staff tradition, as well as the department chair, i.e., A.M. Harvey, dictated that responsibility for our patients was a 24/7 responsibility. The concept of ownership of the patient was so ingrained in us at Hopkins that it carried over to later times — in my own case, over all my life.
Another concern I have is related to obtaining a consult on our patients. I make it clear to house staff that a consulting physician is a consult to those requesting the consult, not to the patient. It is then the responsibility of the patient’s primary doctor to transmit what he or she has been advised by the consulting physician to the patient. I have always agreed with Dr. Eugene Stead, who has many times said, “What this patient needs is a doctor.” The patient does not need several physicians taking care of them at the same time. I try to pass this concept on to house staff, but on many occasions, house staff are not available to discuss the patients, since it is their “day off” in the middle of the week, or they have to go to a clinic.
Based on my experience over the years, I am predicting that in the not-too-distant future, patients will not have a doctor but a cadre of physicians and/or other practitioners who manage them (and confuse them), excluding the physician who is responsible for the patient. This will be a rather sad day for medical education and for our patients.