Hospitalists and liability: Surprising findings that point back to patient safety

Perhaps surprisingly, their main finding was that the rate of claims against hospitalists was significantly lower than for nonhospitalist internists, emergency medicine physicians, general surgeons, and obstetri- cians-gynecologists. We say surprisingly, because health systems utilizing hospitalists generally include features that might increase the risk for malpractice claims. For example, new patients are typically assigned to whichever hospitalist is up for the next admission. Research shows that strained patient-physician rela- tionships increase the risk for malpractice claims. 4,5 Schaffer's data suggest that lack of a preexisting rela- tionship is a challenge, but one to which most hospi- talists have grown accustomed. Hospitalists develop and hone skills that allow them to quickly establish rapport with patients and families. Moreover, though patients seldom choose their hospitalist, they often do select the hospital in which they receive their care. The research group of 1 of the authors was recently surprised to find patients had high levels of trust with their hospital physicians, despite frequently being unable to name them or identify their role. 6 We sus- pect patients in the study had high levels of trust with the hospital and transferred this trust to their assigned physicians as representatives of the organization. Cer- tainly, this hypothesis needs to be tested, and in no way does it minimize the importance of a strong patient-physician relationship. In addition, patient-physician continuity has long been felt to be paramount to safe and effective care; however, it is difficult to achieve in hospitalist sys- tems. Hospitalized patients experience multiple hand- offs, including those at admission, for night coverage, and at the time of service change (ie, end of rotation/ stint). The potential for loss of information is enor- mous. Though increased attention has been dedicated to handoffs among housestaff, little work has been done to describe issues related to handoffs among practicing physicians. However, some discontinuity may be advantageous. A physician newly taking over patient care from another may not be anchored to the initial diagnosis and treatment plan established by the first. This free "second look" may actually prevent missed/delayed diagnoses and optimize plans of care, further reducing harm from care and risk of malpractice. 7