Dealing with the Hospitalist Physician

Every time my mother exacerbates her COPD and is hospitalized, I end up dealing with the Hospitalist, a physician employed at the hospital who is the primary caregiver for her. Although the Hospitalist does defer to my mother's own physicians on a consultation basis, he is the responsible party for enacting her treatments, medicines, and surgeries. This usually (always) causes conflicts with her entire COPD regimen that has been established by the doctors she sees on a regular basis.

An example is her thyroid medication. Every time she is hospitalized, the amount of thyroid medicine (dosage) is changed. Considering I suffer from this same autoimmune issue as my mother, I am well aware of how your thyroid levels can and do change under stress and illness. If you are being hospitalized, you are stressed and ill. And yet every time the hospitalist will change or even eliminate her prescribed dosage. This really bothers me as I feel that too much emphasis is placed on her thyroid rather than the real reason she is there for – her COPD exacerbation. 

In my way of thinking, I am wondering why a doctor who has never seen this patient before and who will hopefully go home within a few days feels the need to mess with her prescriptions. I can see informing the patient and their family that the blood work showed an abnormal thyroid level and this should be checked once she is home and recovered, but I cannot see changing it right then and there. Plus the fact that the patient is on a large amount of antibiotics which will affect the thyroid hormone levels in the blood stream.

I understand that finding anything irregular with the blood work is important and should be dealt with, however it takes time to change or adjust the thyroid hormone levels which needs to be monitored by an endocrinologist. It is not like my mother can return to the hospital a week after discharge and request another blood test on her thyroid. 

Another medicine that is changed is her blood pressure medicine. She takes two different ones and when she is in the hospital, her blood pressure is always elevated. However this is not taken into account, in fact the only thing considered is her blood pressure is high and so the hospitalist will either increase the dosage of her medicines or will add in an additional blood pressure pill to try and lower it. Again, it is not like she can go back and get a check-up from this physician so why make that change?

Yes, my mother has a history of heart disease along with her COPD but changing her prescriptions while she is there is ridiculous. When we see her regular doctors, all prescriptions are changed back so what's the point?


Health Advocate

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