Maybe Hospitals Need Continuitionsists, Too

Wednesday’s Wall Street Journal provided an article by Laura Landro about the use of “proceduralists” in hospitals. This is an idea whose time has come… and we almost have to wonder what on earth took them so long?

Landro defines a proceduralist as a medical specialist who is highly skilled in one or two skill-specific procedures, such as spinal taps or paracentesis or specific catheterizations. Their work is focused not on a specific patient; rather on repeating those procedures all day long on any patient that needs them. Because they are so skilled, and because other doctors aren’t, the chances for botched procedures and — of course — malpractice suits are reduced.

Genius, really. And its implications are numerous.

Hospitals have wisely segmented work for years now, but rarely in the doctoring arena. Nurses no longer change the sheets on the beds — now the housekeeping staff does that. Nurses no longer deliver food — the cafeteria/food workers do that. Instead, nurses are tasked with their better and educated skills; direct care for patients.

Outside of body system specialties, like cardiologists or pulmonologists, or disease specialties, like oncologists, the only doctor-related segmentation I’ve been aware before now of is the use of hospitalists. They are doctors who work directly for the hospital and only see patients in that hospital. They replace the physicians that send their patients there to begin with. I’ve podcast about hospitalists previously. You can listen here.

So let’s consider a few other segments now, too…..

I hear complaints all the time about how lousy doctors are at communicating. So what if we had medical communicationists? Or maybe they could be bedside-mannerists?

And what about the doctors who have lousy handwriting? Bring in the calligraphists! (Can’t call them calligraPHERS because it doesn’t sound medical enough.)

Yes, of course, I’m just jerking a few chains here. I actually think the idea of proceduralists is an excellent idea, because I do believe they can improve the safety and percentage of successful outcomes due to their skills.

My only concern is that we once again lose that big picture person. If portions of care are too segmented, then who is looking out for the whole patient? Who recognizes that the patient needs someone to explain things, to calm him, to INFORM him, and to make sure that the right procedures are actually being conducted at the right times?

Some segmentation is very pro-patient — safety and better outcomes result from capitalizing on doctor skills. But too much segmentation decreases the chances for continuity of care. And that leads to medical errors and reduction in patient safety.

So — maybe hospitals need care continuitionists, too.

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Trisha Torrey
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