Dr. Brooke Williams was treating a COVID-19 patient who knew she was close to dying. I need you to call my family so I can say goodbye, the patient told Williams.
“It is one of the saddest stories, but you are essentially that patient’s family member while they’re in the hospital,” said Williams, a hospital-based doctor at Novant Health Forsyth Medical Center in Winston-Salem. “They can talk to them on the phone, Skype or Zoom, but it’s not the same human touch.”
That’s just one glimpse of a special breed of doctors many of us have never encountered — hospitalists. They’re hospital-based physicians who spend all their time caring for patients being treated in hospitals. And they’ve become front and center as COVID-19 swept across the world, killing more than 350,000 people in the U.S. alone.
They work closely with nurses, respiratory therapists and other providers. All work together under the strain of COVID-19 care that involves caring for profoundly ill patients, constant changing of protective gear and learning what care works best.
Many of their patients go home. Some don’t. “Being bedside with those patients definitely is important. We're trying to do the best we can to have the best outcome,” Williams said.
“Hospitalists serve as the quarterback for the care of the patients in the hospital in that they involve the appropriate specialist as needed,” said Dr. Samara Llewellyn, the physician market executive for hospital-based medicine in Novant Health’s Winston-Salem market. She oversees nearly 100 providers, including Williams.
Hospitalists normally work grueling 12-hour shifts for seven days on, followed by seven days off. There are roughly 160 hospitalists throughout Novant Health, and a hospitalist is available around the clock.
A key difference between a hospitalist and someone’s primary physician is the doctor-patient relationship. A primary physician often can build a long-term relationship with the patient and know their medical history well. A hospitalist may only see a patient once.
“We are seeing the patient usually for the first time,” Llewellyn said. “Sometimes they come with a lot of medical problems that we have to be astute at sorting through quickly, and figuring out the main reason they’re here. It is important that the patients trust us. We have to be able to develop a relationship quickly with the patient and the family.”
Seeing to the patients’ immediate needs
A hospitalist will usually examine a patient as soon as they’re admitted to the hospital. Hospitalists can order X-rays, tests and lab work, and order medical treatments and services. For instance, a patient with an infection may need a prescription for an antibiotic. Or, they can order respiratory therapy for someone with pneumonia.
“I tell patients `I'm kind of like your cruise director,’ Williams said. “I will advocate for you if there is something you feel isn’t going right or someone is not listening to you.
Llewellyn said most hospitalists like to see the impact of what they do, which usually happens faster than a patient in a clinical setting.
“We see patients with an immediate need, which is why they’re in the hospital,” she said. “Being a hospitalist, you get the gratification of that need being addressed a lot quicker.”
Gathering together has been postponed
Hospitalists deal with the mental strain of COVID-19, from treating the increasing number of patients with the virus to worrying about contracting it themselves. They, like everyone in contact with patients, work every shift covered in protective equipment. It protects them and patients, but takes away from team cohesiveness.
Before COVID-19, the hospitalists would gather as a team 15 minutes or so before their shift began, Llewellyn said. They’d exchange notes about what patient needed what and discuss strategy. They also ate lunch together every day. Because of COVID-19, those meetings and lunches don’t happen.
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“We've had six new doctors start in the middle of the pandemic,” Llewellyn said. “I think that has to be one of the hardest things for these new doctors, joining a group and not even knowing what all your teammates look like.”
One of those new hospitalists is Williams, who joined Novant Health in September. There are a few teammates she’s only seen wearing protective masks and shields.
“I'm a very extroverted person,” she said. “I like being around people. I like talking, so it's been a little difficult. I know this group was big on having outside functions, and making sure to have camaraderie amongst the team.”
Llewellyn said she isn’t organizing any of the usual team activities that brings the hospitalists together, for fear of spreading the virus. The Christmas party didn’t happen this year. They meet via Zoom at least every month.
“We're all in this together,” Williams said. “Our emotions may wax and wane or differ slightly from one another, but it's important to talk about it and not try to keep it in. People were saying we on the front line are heroes. We’re not looking for that word. We're looking to be human.”
MAIN PHOTO: Dr. Sommany Weber (left) and Dr. Na Li are hospitalists who treat patients at Novant Health Forsyth Medical Center in Winston-Salem.