ROANOKE TIMES
Copyright (c) 1995, Roanoke Times
DATE: Sunday, December 31, 1995 TAG: 9601020129
SECTION: BUSINESS PAGE: D-1 EDITION: METRO
COLUMN: MEDICINE
SOURCE: SANDRA BROWN KELLY
Here's a question for your family doctor: "If I have to go in the hospital, Doc, will you be in charge of my care?"
The answer from some physicians may come as a surprise to patients.
More and more family physicians are deciding that their time is better spent in the office seeing patients. If one of the patients has to be admitted to the hospital, he or she will be turned over to a hospital-based team of doctors.
This year in the Roanoke Valley, two independent, family-physician practices - Brambleton Family Physicians and Salem Family Practice - decided to change their structures and specialize in office treatment.
Salem Family announced the change in letters to patients. Brambleton Family chose not to send letters but to try to explain the change as needed, said Dr. Don Smith, one of the practice's five doctors.
In this specialized setup, the family-practice doctor might speak with hospital doctors by phone or send material by fax about a patient who is hospitalized. But decisions about that patient will be made by the admitting doctors.
Lewis-Gale Clinic family-practice physicians have had a pass-along system in place for three years. Instead of turning their hospitalized patients over to a hospital-based doctor, Lewis-Gale physicians refer patients to a clinic colleague who is a specialist. The specialist then admits the patient to the hospital.
Dr. Bruce Hagadorn, the clinic's medical director, said some patients still express concern about the process, but he would rate the system as ``relatively successful.''
The clinic explains the setup in brochures, he said.
The practice of passing a patient to another doctor is what used to happen when a rural practitioner turned a complicated case over to a specialist in the city. The specialist had the expertise, and he didn't have a long drive to the hospital.
Specialists generally are involved when people are hospitalized anyway, Hagadorn points out.
For a patient, though, being passed from a family doctor to another physician means leaving the security of an established relationship and being thrust into the care of a stranger at a stressful time.
As one mother said recently when her son, a patient at Brambleton Family Physicians, was admitted to the hospital under the care of a Roanoke Memorial Hospital medical team: "Here my son lies, and I don't know anything about the doctor who's seeing him.''
The Brambleton group began the new setup in May, but had been thinking about doing it for at least three years, Smith said.
The response generally has been positive, he added.
``It's difficult any time you make a change, but we made sure it wouldn't affect patient care,'' Smith said.
If one of his patients is admitted to the hospital in an emergency, his office is supposed to be notified and then any exchange of information or records is possible through a direct fax hookup, he said.
The team approach gives Smith and other doctors in the practice more time to see more patients at the office because they don't have to make trips to the hospital. In turn, Smith said, the hospital physicians have constant experience dealing with patients who are sick enough to be hospitalized.
Smith said he and the hospital doctors are also getting to know each other really well because they have to work together.
The specialization almost couldn't be helped because of the demands made on family-practice physicians as the core of managed medical care. In many health care plans, the family practitioner serves as the front-line health care provider, funneling patients to specialists as he sees fit.
This central role, coupled with the need to compete with other physician groups for patients, is forcing these doctors to be more accessible, to be prompt at seeing patients and to keep their offices open longer hours.
Brambleton, for example, has extended weekday hours and is open from noon to 6 p.m. on Saturdays and Sundays.
The team approach has "gone excellently," said Dr. Legree Hallman, an internist and one of the doctors who takes over the hospitalized patients of Smith's group.
Hallman is an employee of Carilion Health System's medical education department and an associate professor in the University of Virginia's family-practice physician program. He said he tries to reassure new patients by introducing himself as their primary-care physician, when he makes rounds with medical residents and interns.
Many patients have appreciated the attention they have received from the team of doctors, Hallman said.
Besides, he said, some of the family physicians still make visits to the hospital to see their patients and reassure them.
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