3 Questions With... Ali Farhat, MD, Director, Division of Hospitalist Medicine, William Beaumont Hospital

1 How do you describe your roll as a hospitalist to patients who may be unfamiliar with the term or the idea behind it?

When we [hospitalists at Beaumont] meet patients for the first time who have never heard of hospitalists—be they patients who don’t have an outpatient doctor or patients who we see when covering for private physicians on the outside who contract with us—we explain that we are specialists in inpatient medicine; we’re the equivalent of their outpatient doctor. We describe the relationship with their referring physician as an affi liation, not fi nancially, but just from a coverage perspective. We explain that we have a partnership in which we share information. When we form a relationship with an outside, referring doctor, we encourage that physician to explain when they see their patients for regular follow-ups that they’re contracted with a hospitalist to take care of their inpatient work, but that they’re still in the loop and have a say in that patient’s care; they just won’t be visiting the patient in the hospital. Some doctors do come for social visits, but we encourage physicians to explain the situation to the patient so it’s not a total surprise that we’re treating the patient and not the referring physician. Even if it is a total surprise, we explain to the patient that it’s just a direction a lot of physicians are going in because of time constraints in going back and forth from the office.

2 How do you establish a relationship with a patient who is only going to be in your care for a short time?

With almost all patients, you can see the skepticism on their faces initially; they don’t know who you are. You need to establish credibility with the patient by providing them the best care. Right from the start, I do a detailed history and go over every aspect of their record. Typically, before I see patients, I will review their records from the computer system or whatever records I obtained from their regular physician’s offi ce. I then confi rm everything with the patient. It helps patients gain confi dence in you when you’re not totally unfamiliar with them and not starting from scratch.

When I perform an exam, I really pay attention to details with them. Spending extra time with the patient—sitting down with them, allowing them to ask questions, proving that I know the details of their case—reassures the patient that we’ve addressed all the issues. In that hour of initial contact—including computer and record review, talking to the family and patient, examining the patient—I establish a rapport with the patient.

3 How do you address the challenges of coordinating care with a patient’s primary care physician to ensure continuity of care, and how does that affect the relationship with your patients?

It’s a challenge for everybody right now, mostly due to the lack of a unifi ed electronic medical record (EMR) system. Coordinating with referring physicians is mainly a manual process I have to pick up the phone and call the physician every time there’s a change. We use e-mail, but not all physicians do. If we need to share lab or test results with referring physicians and they don’t have access to our system, we have to call them. If the referring physicians did have access to the same EMR system, I could send an auto-notifi cation that pops up in their inbox, telling them their patient is here and under my care. Th at gives them a cue to go and look up the pertinent information and keep track of what’s going on. EMR systems aren’t going to replace the need for verbal communication with referring physicians, but they will make coordinating much more effi cient. We have an EMR here at Beaumont, but it’s not unifi ed and doesn’t incorporate all the referring physicians. In about two years, we will be moving to a system that will allow access to all referring physicians, and patients will be able to access their own portion of their chart. Th at’s going to go a long way in establishing better and more effi cient communication.

Currently, we have a system in which, once the patient comes in and we know they’ll be admitted, we go through the list, identify their referring physician, and send a fax notifying him or her that their patient is here with whatever diagnosis, and we ask them to please call us if they have any questions. We have a secretary who calls to get any records that can be faxed to us from the offi ce and distributed to the proper charts.

For discharges, we have a preference list from the referring physicians. Physicians who do have access to the system don’t need us to mail or fax them everything. We just notify them when the patient has gone home, and they can get what they need. It’s a cumbersome system, because you have to remember everyone’s preferences. It’s not as streamlined as it would be with just one system for communication.

As long as a patient knows that you’re communicating with their referring physician—typically, they do because the family members of most patients call the referring physician, even though the patient is in the hospital, to get their opinion on things—and the referring physician knows what’s going on, it gives them the extra assurance that the referring physician is still involved.