Introduction
The emergence of a new medical specialist known as the "hospitalist". Hospitalists are physicians assigned to direct the overall medical care of hospitalized patients: they interact with treating specialists, decide when to admit and discharge patients, and assume the other medical duties that traditionally have been the responsibility of the patient's personal physician. This means that a patient sick enough to be hospitalized will not be under the care of the doctor they may have known for years, even though it is at just such a time that the link of trust forged over many years between patient and doctor is most important. (Robert M. Wachter and Lee Goldman, 1996)
Hospitalists are not paid by patients; they are employees of the hospital in which they work, or independent consultants who have contracted to provide hospitalist services. A major purpose of the hospitalist movement is to reduce costs and improve efficiency without compromising quality of care. These are certainly worthy goals. But hospitalists will also become major providers of end-of-life care. That could help improve pain and symptom control, since many family doctors and internists have inadequate training in end-of-life care. But the emergence of hospitalists is very worrisome in the context of Futile Care Theory. They will be virtual strangers to the patient and family, and their primary emotional loyalty, albeit not necessarily their professional responsibility is likely to be to their institution. This could leave marginalized patients at material risk of being written off as futile care cases. This worry is heightened when advocates of the hospitalist movement urge practitioners to obtain "superb training in biomedical ethics." (David Lawrence, MD, 2002)
Today the typical hospitalist is an internist (about 20% are pulmonologists or family practitioners) who spends most if not all their time in the hospital. They may.......
