Is this the state of healthcare in America??

Recently I read a CT scan and identified large clots in the right and left main pulmonary arteries. ("Bilateral pulmonary emboli") As summarized here, studies have "estimated that more than 1,000,000 people in the United States are affected by pulmonary emboli each year, with 100,000 to 200,000 of these events being fatal."

When I finally, after 15 minutes of trying, reached the nurse practitioner on call for the hospitalist group caring for this patient, she asked me, "Is that critical? Do I need to call the ICU?"


Holding back a bit, I politely replied, "Although that decision is up to you taking care of the patient, this is a life-threatening emergency. I would do so if I were taking care of her."

I have several friends who are excellent hospitalists. It's not an issue whether the hospitalist is good or bad, though that of course is important to note. But it is very important that we recognize that care by hospitalists is fragmented unless said hospitalist is on duty on a more continuous basis. There are solo hospitalist practitioners who care for their patients on a daily basis and have more exclusive practices than others. But hospitalist groups tend toward more shift work and I think that is a major failing of the current method of inpatient care.

Oh, and by the way, in Florida, there is a bill being pushed in the Florida House and Senate to allow nurse practitioners to care for patients independently. I know several excellent nurse practitioners. But it's the overall system failing I am pointing out to inform and educate so that patients are aware of what is happening. Nurse practitioners work best in concert with physicians. Nurse practitioners and physicians train differently and gather differing experiences. They are best when working together and complement each other. Hospitalists best know their patients when they are not on-off-on-off shift workers. I know several hospitalists who only care for certain issues, or who work in a small group or solo, allowing for a continuity of care that large hospitalist groups can absolutely not match. Those are important distinctions that are being overlooked thanks to meaningless discussions about slow websites!