AMANE KANEKO

“Hospitalism” Isn’t the Same as HM

If hospitalists are doctors who provide care to hospitalized patients, is the correct term for the care they provide “hospitalism”?

P. Doherty, DO

Fort Collins, Colo.

Dr. Hospitalist responds: I am of the belief that the correct term for the general medical care of hospitalized patients is “hospital medicine.” Hospitalism is a term I’ve heard used interchangeably with hospital medicine, but I do not believe it accurately describes the field of medicine practiced by hospitalists.

The dictionary, and online resources like Wikipedia, describes “hospitalism” as a medical condition suffered by children who were “institutionalized for long periods and deprived of substitute maternal care.” This term was first described in the late 1800s and popularized by psychotherapist Rene Spitz in 1945.1

Lee Goldman, MD, and Robert Wachter, MD, FHM, coined the term “hospitalist” in a landmark 1996 New England Journal of Medicine article. Dr. Goldman describes hospitalism as “[a] variety of iatrogenic maladies that were acquired by hospitalized patients and that often were more deadly than the admitting condition itself.” In fact, he described hospitalists as “a cure for hospitalism.”2

I had never heard of the term hospitalism and did not understand its definition before I became a hospitalist. As a hospitalist, I prefer to practice hospital medicine.

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Do you have a problem or concern that you’d like Dr. Hospitalist to address? E-mail your questions to drhospit@wiley.com.

Don’t Give Up on Hand-Hygiene Compliance

I am the director of a hospitalist group. How do I convince my colleagues to wash their hands?

B. Hunter, MD

Dr. Hospitalist responds: Dr. Hunter, don’t feel discouraged. You are not alone. Appropriate hand hygiene in the hospital setting is a difficult nut to crack. In some ways, I liken hand-washing noncompliance to smoking or eating junk food: We know that it is bad for us. None of us dispute the facts. There is plenty of research to support the fact that smoking causes chronic obstructive pulmonary disease and lung cancer; junk food causes obesity, which leads to heart disease and other ailments. But the truth of the matter is that many of us have a hard time resisting cigarettes and greasy burgers.

Hand hygiene is no different. It’s habitual. If it is not part of your routine, cleaning your hands before and after you enter a patient’s hospital room is time-consuming. But the truth remains: There is so much at stake.

Setting cost aside, hospital-acquired infections are a significant cause of morbidity and mortality. We know hand hygiene works. We also know that it is the right thing to do. If any of us were hospitalized, would we want our providers to clean their hands before examining us?

If the hospital where you work is like his or mine, hand-cleanser dispensers are conveniently located near the entry to every patient room. Signs urging compliance are plastered all over the place. The rules are clearly outlined and the rationale thoughtfully explained. Despite that fact, some providers, doctors, nurses, and others simply choose to ignore all the facts and reminders.

Some medical leaders believe hand-hygiene noncompliance is a medical error, and rogue providers should be punished for ignoring patient-safety measures. I agree. If your institution does not yet have a hand-hygiene program in place, it is incumbent on you and the hospital to institute one. If you have a program and providers ignore the rules, it is time to monitor compliance and punish the individuals who are putting our patients’ well-being at risk. TH

References

Crandall FM. Hospitalism. Neonatology on the Web site. Available at: www.neonatology.org/classics/crandall.html. Accessed Sept. 12, 2009.

Goldman L. Hospitalists as cure for hospitalism. Trans Am Clin Climatol Assoc. 2003;114:37-48.