Family Medicine belongs in Hospital

“Hospitals are dangerous for the elderly who are susceptible to hospital infections and rapid deterioration from the change in environment.”

Ian McWhinney, Textbook of Family Medicine, 4th Edition

This week, I visited one of my elder patients from my Family Practice who was admitted to hospital with pneumonia. When I walked into the room and he recognized my familiar face, his face lit up! He had been struggling with said condition and complications (pericardial effusion and new onset atrial fibrillation). He was being followed by a very kind and caring Internal Medicine specialist (thank you, Dr. C!).

My patient had lost track of how many days he was in hospital and unsure of what was happening to him. I was able to take the time to explain, reorient and reassure him his diagnoses and the plan to get him home as soon as possible. I was also able to connect with his family and update them of their loved one’s situation. As well as advocate for his care with his hospital-based team while he is in hospital.

Having an elder (or any patient) in hospital makes me nervous (see above quote), I feel the longer they are in, there is an increased risk to succumbing to negative sequelae of their illness and other things (deconditioning, cognitive decline, falls, bed sores and blood clots to name a few). As said, this is not a condemnation of the amazing work that our colleagues do in hospital. It’s a scientific fact.

This is where relationship and longitudinal care in community can further heal and protect patients to return back home as soon as possible (see https://blueskyfamilymedicine.family.blog/2020/06/07/there-is-no-place-like-a-home-visit/). At NRGH, the data shows that a patient under the care of a Family Doctor stays at least 2 less days in hospital. That’s 2 less days of the above risks and savings to the ailing healthcare system.

With our healthcare system in crisis in and out of hospital, now more than ever do we need to have relationship-based and longitudinal care Family Medicine and advocacy for patients in hospital and out in the community!

The Blue Sky Family Medicine Innovation would be for Family Doctors to visit their patients in hospital (especially if hospitalized for more than 4 days) and help support patients and their families (family meeting, anyone?), give treatment advice to the hospital-based team for ongoing care and help with discharge planning back to home in community. It would be no different than doing a Home Visit, but instead in hospital. The timing of the visit would be coordinated with the Family Doctor and patient (and family)!

Relationship heals.