Would you be my doctor?

"Well, I was wondering if you would be my family doctor."

The question completely surprised me. Minutes earlier, I had been called to the main lobby of our hospital. A patient I briefly cared for more than 2 days was asking to see me. I went to the lobby uncertain of the reason for the visit, but happy to see the man – we had developed a nice bond during our brief physician-patient relationship.

"I really liked the fact that you sat down and talked with me and taught me things about my diabetes. I actually understood what you were saying, and I thought you would help keep me on the path to getting healthier."

I felt a surge of emotion – almost to the point where my eyes welled up. Thankfully, I caught the surge and channeled it into an appreciative smile. I was genuinely touched that he felt comfortable with me and trusted me enough to ask me to partner with him for his health.

"I was just over at Dr. Q’s and showed him my blood sugars – they are doing much better and I already feel clearer. I figured I would just pop in here and ask you."

He had been a direct admission from the endocrinologist’s office where his blood glucose was well over 500 mg/dL. He demonstrated no evidence of acidosis or hyperosmolar state – he was simply a poorly controlled diabetic. He had previously seen a different endocrinologist and they had clearly not clicked for a variety of reasons. Based upon my initial interview with him, he also was not enamored with his primary care physician.

"You know, since my diabetes doctor is here and my cardiologist is joining you guys, I thought it would be great to have all of my doctors here."

I admired his recognition that having his physicians under one roof should lead to improved coordination of care. My new hospital is in a relatively small integrated network, allowing for prompt communication among providers regarding our patients. However, I could not take him on as a patient.

"I’m so flattered that you are asking me to be your primary care physician. Unfortunately, I’m not going to be able to do it. My practice is limited to the hospital, so unless you want to get admitted to the hospital periodically, I’m not going to be able to see you."

As much as I did not mesh with outpatient medicine as a resident and during my first year as an attending (when I had a small office practice), I was sad that I could not take him on as a patient. Part of me misses the longitudinal relationships with patients. I like hearing about life events and milestones, the everyday comings and goings. The truth is, as a hospitalist, we are generally not happy to see our "frequent fliers." They either have diseases that we cannot fix – only temporize – or they come into the hospital for questionable secondary issues that stress us and raise our anxiety level.

I firmly believe one of the underlying currents behind the slow creep of hospital medicine into skilled nursing facilities, discharge clinics, and the development of "extensivists," is the desire to have that bond with our patients. We meet and treat patients when they are at their sickest. Our relationships are therefore intense, but brief. I think we want to have longer and deeper interactions with our patients than we are able to achieve in the present model. It will be interesting to see how the model evolves to accommodate the more traditional physician-patient relationship.

"I understand, Doc. As much as I like you, I don’t really want to have to come back here to see you. Maybe at the grocery store or something like that instead."

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

"Well, I was wondering if you would be my family doctor."

The question completely surprised me. Minutes earlier, I had been called to the main lobby of our hospital. A patient I briefly cared for more than 2 days was asking to see me. I went to the lobby uncertain of the reason for the visit, but happy to see the man – we had developed a nice bond during our brief physician-patient relationship.

"I really liked the fact that you sat down and talked with me and taught me things about my diabetes. I actually understood what you were saying, and I thought you would help keep me on the path to getting healthier."

I felt a surge of emotion – almost to the point where my eyes welled up. Thankfully, I caught the surge and channeled it into an appreciative smile. I was genuinely touched that he felt comfortable with me and trusted me enough to ask me to partner with him for his health.

"I was just over at Dr. Q’s and showed him my blood sugars – they are doing much better and I already feel clearer. I figured I would just pop in here and ask you."

He had been a direct admission from the endocrinologist’s office where his blood glucose was well over 500 mg/dL. He demonstrated no evidence of acidosis or hyperosmolar state – he was simply a poorly controlled diabetic. He had previously seen a different endocrinologist and they had clearly not clicked for a variety of reasons. Based upon my initial interview with him, he also was not enamored with his primary care physician.

"You know, since my diabetes doctor is here and my cardiologist is joining you guys, I thought it would be great to have all of my doctors here."

I admired his recognition that having his physicians under one roof should lead to improved coordination of care. My new hospital is in a relatively small integrated network, allowing for prompt communication among providers regarding our patients. However, I could not take him on as a patient.

"I’m so flattered that you are asking me to be your primary care physician. Unfortunately, I’m not going to be able to do it. My practice is limited to the hospital, so unless you want to get admitted to the hospital periodically, I’m not going to be able to see you."

As much as I did not mesh with outpatient medicine as a resident and during my first year as an attending (when I had a small office practice), I was sad that I could not take him on as a patient. Part of me misses the longitudinal relationships with patients. I like hearing about life events and milestones, the everyday comings and goings. The truth is, as a hospitalist, we are generally not happy to see our "frequent fliers." They either have diseases that we cannot fix – only temporize – or they come into the hospital for questionable secondary issues that stress us and raise our anxiety level.

I firmly believe one of the underlying currents behind the slow creep of hospital medicine into skilled nursing facilities, discharge clinics, and the development of "extensivists," is the desire to have that bond with our patients. We meet and treat patients when they are at their sickest. Our relationships are therefore intense, but brief. I think we want to have longer and deeper interactions with our patients than we are able to achieve in the present model. It will be interesting to see how the model evolves to accommodate the more traditional physician-patient relationship.

"I understand, Doc. As much as I like you, I don’t really want to have to come back here to see you. Maybe at the grocery store or something like that instead."

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

"Well, I was wondering if you would be my family doctor."

The question completely surprised me. Minutes earlier, I had been called to the main lobby of our hospital. A patient I briefly cared for more than 2 days was asking to see me. I went to the lobby uncertain of the reason for the visit, but happy to see the man – we had developed a nice bond during our brief physician-patient relationship.

"I really liked the fact that you sat down and talked with me and taught me things about my diabetes. I actually understood what you were saying, and I thought you would help keep me on the path to getting healthier."

I felt a surge of emotion – almost to the point where my eyes welled up. Thankfully, I caught the surge and channeled it into an appreciative smile. I was genuinely touched that he felt comfortable with me and trusted me enough to ask me to partner with him for his health.

"I was just over at Dr. Q’s and showed him my blood sugars – they are doing much better and I already feel clearer. I figured I would just pop in here and ask you."

He had been a direct admission from the endocrinologist’s office where his blood glucose was well over 500 mg/dL. He demonstrated no evidence of acidosis or hyperosmolar state – he was simply a poorly controlled diabetic. He had previously seen a different endocrinologist and they had clearly not clicked for a variety of reasons. Based upon my initial interview with him, he also was not enamored with his primary care physician.

"You know, since my diabetes doctor is here and my cardiologist is joining you guys, I thought it would be great to have all of my doctors here."

I admired his recognition that having his physicians under one roof should lead to improved coordination of care. My new hospital is in a relatively small integrated network, allowing for prompt communication among providers regarding our patients. However, I could not take him on as a patient.

"I’m so flattered that you are asking me to be your primary care physician. Unfortunately, I’m not going to be able to do it. My practice is limited to the hospital, so unless you want to get admitted to the hospital periodically, I’m not going to be able to see you."

As much as I did not mesh with outpatient medicine as a resident and during my first year as an attending (when I had a small office practice), I was sad that I could not take him on as a patient. Part of me misses the longitudinal relationships with patients. I like hearing about life events and milestones, the everyday comings and goings. The truth is, as a hospitalist, we are generally not happy to see our "frequent fliers." They either have diseases that we cannot fix – only temporize – or they come into the hospital for questionable secondary issues that stress us and raise our anxiety level.

I firmly believe one of the underlying currents behind the slow creep of hospital medicine into skilled nursing facilities, discharge clinics, and the development of "extensivists," is the desire to have that bond with our patients. We meet and treat patients when they are at their sickest. Our relationships are therefore intense, but brief. I think we want to have longer and deeper interactions with our patients than we are able to achieve in the present model. It will be interesting to see how the model evolves to accommodate the more traditional physician-patient relationship.

"I understand, Doc. As much as I like you, I don’t really want to have to come back here to see you. Maybe at the grocery store or something like that instead."

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.