A new doctor in the house - Ethical issues in hospitalist systems

The traditional patient-primary care physician (PCP) relationship provides many ethical protections for patients, including confidentiality, shared me dical decision making, and respect for patient autonomy. Hospitalist models , which introduce a purposeful discontinuity of care, threaten these protec tions and raise certain ethical concerns. We analyze 2 cases that explore e thical issues arising in hospitalist systems and suggest ways to ensure eth ical protection for patients. The first case examines how hospitalization c an disrupt the patient-PCP relationship and raise ethical issues regarding confidentiality. In the second case, we discuss decision making when the pa tient's goals and preferences for care change as a result of hospitalizatio n. Effective hospitalist systems provide a model for a trusting patient-phy sician relationship. Although the hospitalist must take responsibility for inpatient management, the PCP has a key role in addressing important issues in the hospital and providing care after discharge. As hospitalists assume control of inpatient care, they must also provide ethical protections to p atients to supplement those currently vested in the patient-PCP relationshi p. An approach that keeps the patient's best interests foremost, defines a clear role for the PCP, and takes advantage of the expertise and availabili ty of hospitalists will best serve patients and physicians.