Finding Connection in Hospital Medicine

Hospital medicine is frequently defined by a specific set of challenges, including high patient turnover and an emphasis on acute care. However, instances of long-term connection within the specialty are not uncommon. A hospitalist recently described how previous interactions with patients can resurface during current admissions, challenging the notion that doctors in this field must sacrifice continuity for acuity.

Heart Failure and Familiar Faces

On one recent shift, a new admission was announced: Jacqueline Alberts, admitted for heart failure exacerbation. The senior resident placed her on the list, but the attending recognized the name. “Wait, I know her,” the doctor recalled saying. “I sent her home with hospice three years ago because the side effects of her cancer treatment had become too much.”

A review of her chart showed that since the last time she was treated, her cancer had remained stable without further directed therapy. However, for the past year, she had suffered a heart attack, leading to an ICU stay and ischemic cardiomyopathy, along with atrial fibrillation resistant to control measures. This admission marked her third heart failure exacerbation in as many months.

As the team went to admit her, the doctor reintroduced himself. “Hi, Jacqueline,” he said, “I’m not sure if you recall, but I cared for you a few years back.”

“I remember you,” she replied in a stoic tone. “You’re my doctor.”

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Throughout the admission, she consistently refused her diuretics unless the doctor led the rounds. “If you tell me to do it, I’ll do it, but I need to hear it from you because you’re my doctor,” she told him. This trust highlighted a relationship formed years prior, despite the short duration of that previous care.

A Shift in Patient History

The stories of connection extend beyond those with obvious positive outcomes. Another familiar name appeared on the list, but the doctor had less positive memories of the history. Robert had been admitted numerous times over the years, primarily due to issues stemming from opiate use disorder.

When the doctor approached with his team, Robert greeted them. “Good to see you, Doc,” he said with a smile. The doctor noticed an immediate change in his demeanor. He used to be angry and defensive, but now he was friendly and welcoming.

“Great! I’ve been clean for four years now. This is my first hospital visit in over three years. Remember how I used to be in here every month?”

During Robert’s stay, the doctor learned how Suboxone had helped him achieve remission from his opiate use disorder. He was a guitarist and had found his way back to music, working again. His health was the best it had been in decades. Having known Robert when opiate use disorder dominated his life, the doctor noted the privilege of seeing him succeed.