Doctoring General Medicine Reflection

An under-appreciated “specialty”

Today I would like to say thanks to a group of colleagues that too often go un-thanked.

These would be my hospital-based internal medicine friends: hospitalists are what they are called.

This idea came to me after reading Dr Robert Centor’s post on KevinMD. In his usual concise manner, he laments the lack of respect that many sub-specialists show hospitalists.

I feel differently about my hard-working colleagues.

As a sub, sub-specialist who works primarily in the hospital, I would like to say how grateful I am to have knowledgeable, hospital-based internists available.

I believe, and write frequently about the importance of seeing the forest through the trees. A good doctor must see the big picture: a little atrial fib, for instance, isn’t a major problem if you can’t move, eat or have widespread Cancer.

But for good patient care, the details are important too. Hospitalists are good at details. In fact, an internists’ area of expertise is in using, considering and synthesizing such specifics. They mesh together a patient’s history, exam, laboratory values, X-rays, and other specialists’ opinions. I feel strongly that having thinkers on the case is a good thing.

What’s more, as the technology of medicine expands, the sub-specialists’ scope of expertise grows even more narrow. This fact only increases the value of internists.

Take this humorous story as an example of such narrowness of scope:

A nurse and I were chatting outside a patient’s room in the intensive care unit. A day or so before, I had implanted a pacemaker. We overheard the patient and his wife arguing about whether I could write him a prescription for his blood pressure medicine. The patient said,  “Doctor Mandrola can write me a prescription for this medicine.” The wife countered, “No he can’t…He isn’t a real doctor; he’s just the guy who put in your pacemaker.”  From that day on, this nurse reminds me that I am just an installer, or these days, an ablator. Barely a real doctor.

As one who hangs a lot of self-esteem on how well my patients do, I am grateful to have recently-trained, detailed oriented, conscientious hospitalists around to help me, help my patients.

And I do not begrudge them for finding a job that pays well, and ends at the end of the shift. Good on you; you are probably less likely to get AF.

Thanks, all you hospitalists!


P.S. For the record, Dr Centor is one of my favorite physician-masters-of-the-obvious. He writes frequently on his blog, db’s Medical Rants.

4 replies on “An under-appreciated “specialty””

Dr. M,
As usual I think you presented an excellent point. Throughout school I have heard many people bashing the hospitalist, much like they bash a family/general practitioner. You hear things like, “They weren’t ambitious”, or “They didn’t have what it takes to become a (fill in the blank).”
As a future FNP, I love your insights into the life of medicine, not just the medicine itself.


Well presented. In my hospital, the quality of care has increased with the use of hospitaliists. That patient care would improve with a physician who is in the hospital for 12 hours is self-evident. These docs make several visits to their patients in the course of the day, following-up on all of the day’s medical events. Can physicians who round once daily compete with this? Of course, there are some drawbacks, but I believe they can be effectively addressed. In addition, many of the practicing internists here are delighted to have hospitalized do the grunt work of in-pt medicine, leaving them in their office to attend to their out-patients.

Thanks MK. I agree that hand-offs and fragmentation might be risks, but in general, the hospitalist model is working well for us.

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