Paging Dr. Fox

Broad-based and consistent patient care can lower health care costs.

JEFF MILLER

The tension between generalists and specialists goes back a long way. Archilochus, an ancient Greek poet, contrasted the wise fox, who knows many things, with the hedgehog, who is an expert on one thing. Medicine, in which the frontier is ever broader, and the channels of concentration ever deeper, has long encompassed both foxes and hedgehogs, but the intensity of modern hospital life has increasingly pushed generalists to the fringes of patient care.

That is about to change. Because that breadth of experience and the wisdom it brings can reassure patients—and improve the outcome of treatment—more and more hospitals are recruiting a new breed of generalist. These “hospitalists” supervise a patient’s care from the moment of admission until discharge, a period that typically lasts one to three days. Already 8,000 hospitalists practice in the United States, up from a mere handful a decade ago, and their champions believe that in another ten years, they will outnumber cardiologists.

Like many good new ideas, hospitalists are a marked improvement of an old notion. Primary care physicians, who know their patients best, used to supervise their treatment in the hospital, often in person on regular visits. But the growing pressure on physicians’ time has left them little hope of venturing beyond their clinics, and hospital patients end up getting passed from doctor to doctor. Hospitalists, internists who root themselves in the wards, have mastered the latest inpatient technologies and hospital procedures, and so have now claimed primary responsibility for the patient.