I am “JUST” the hospitalist

I HAVE BEEN a practicing hospitalist for a decade now. Patients often ask, “What is a hospitalist? What do you specialize in?” I usually reply, “I am like your family doctor who works only in the hospital managing your overall care.” Most patients and families know little about the hospitalist’s role in their care, and it is not uncommon for me to hear patients say, “Oh, you are JUST the hospitalist. I am waiting for my heart doctor to come see me”.

One morning, I picked up my patient rounding list as usual—and an uncommon name caught my attention. When I entered the dark room, I saw a young female lying in bed and a man sitting on the corner of the couch, who introduced himself as her husband.

The patient had been admitted the day before with a hemoglobin of 2.5 g/dL. Overnight, she had received three units of blood and was getting her fourth when I came in. I introduced myself and asked her how she was feeling. She replied with a flat affect: “Okay.”

“We couldn’t afford to see a doctor”

I started asking routine questions related to her medical history. That’s how I learned that she had not seen a doctor in the last five years, even though she’d had heavy menstrual bleeding for the last four.

As hospitalists, we have a critical responsibility—as well as the potential—to make a substantial difference in patients’ lives.

Surprised, I asked why she hadn’t seen a gynecologist or primary care doctor until now. (She’d been admitted after a family doctor, during the patient’s first medical visit in years, had diagnosed her with severe anemia and sent her to the emergency department.)

At this, the husband started talking, “We couldn’t afford to see a doctor.” Their family of six—they have four kids—moved to the U.S. from Kenya five years ago. They’d lived in a rural area of Kenya where the patient taught elementary school, and the husband was a pastor, but they struggled financially.

A friend suggested they apply to the Diversity Visa program¹, also known as the “Green Card lottery.” This program provides a pathway for those from countries with low immigration rates to apply for a green card, a unique opportunity to pursue lawful permanent residency in the U.S.

They did apply, and they were approved. When they first arrived in the U.S., the parents worked for a few months and stayed with a “host,” working full-time as caregivers in a group home, before moving.

The patient delivered a healthy baby here but then realized she couldn’t afford health insurance due to high copays and she had no way to access primary care benefits. When they contacted the Department of Economic Security (DES), they were told they must satisfy a five-year waiting period before qualifying for Medicaid or other federal insurance benefits.² They tried to get private insurance but couldn’t afford it.

Engaging the hospital team

At this point, I was baffled, annoyed, and sympathetic to the whole situation. This young couple had sold everything they had to pack and move across the world to pursue a better future for their children.

Yet a few years later, in a dark hospital room with tears rolling down, they reflected on whether it was all worth it. I couldn’t help asking if they’d considered returning. They didn’t respond, but I saw it in their faces: They had nothing to return to. I tried to break the awkward silence by discussing how to manage her anemia and I left.

When I walked out of their room, I initially felt helpless, but I spoke to the case manager to see how we could help. We provided the family with resources and information on how to apply for health insurance for themselves and their children.

The team was able to guide them through that application even while the patient was still in the hospital, making sure she and her family received medical coverage for ongoing outpatient care. They were grateful to us all and thanked everyone before they left the hospital.

Broad responsibility

As I complete my first decade as a practicing hospitalist and survive the COVID-19 pandemic, I realize the U.S. health care system is fragmented and broken and needs an urgent fix.³

As hospitalists, we have a critical responsibility—as well as the potential—to change the health care system and make a substantial difference in patients’ lives. We see patients and their families at their most vulnerable. We can empathize with them, advocate for them, guide them through an extraordinarily complicated system, allay their fears, and restore their lost trust in health care.

I called my patient a week later to see how she was doing. She confirmed progress regarding her health insurance and expressed hope and optimism. She thanked me for taking the time to connect her to the right people who could help her.

So yes, I am proud to be “just” the hospitalist. Often, that’s just what our patients need.

Nikhil Sood, MD, who trained in internal medicine, has been a hospitalist in Arizona for the last eight years. He works in an acute care cancer hospital affiliated with MD Anderson Cancer Center, managing cancer patients and related complications. Follow his Linkedin account and X account here: @sood2026.

References:

1. https://travel.state.gov/content/travel/en/us-visas/immigrate/diversity-visa-program-entry/diversity-visa-instructions.html

2. https://www.kff.org/racial-equity-and-health-policy/issue-brief/state-health-coverage-for-immigrants-and-implications-for-health-coverage-and-care/

3. https://www.health.harvard.edu/blog/is-our-healthcare-system-broken-202107132542