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News Opinion

Hospitals ought to be doing less, not more, in the community [Letter]

I read Anne P. Hahn and Michael Reisch's commentary on hospital reform with sad amusement ("Hospitals too must reform under Obamacare," Nov. 11). Their arguments are all backward.

Hospitals actually need to step back from the their invasion into the community, not become more involved in it. As an internal medicine physician in solo practice for 25 years in Baltimore City, I can relate first-hand to the destructive effect hospital involvement has had on the community.

Not that long ago, there was a clear separation between outpatient and inpatient care, and each was independent of the other. This was a good thing. It allowed primary care physicians like myself to know our patients quite well, and we took pride in keeping them out of the hospital.

Doctors themselves, not their answering service or a covering physician, were always available to these patients, typically defusing an "emergency" without the need of emergency medical care and a trip to the hospital.

We would make house calls if necessary, and in the event a patient needed hospital care, we would follow them in the hospital along with their respective specialist to provide both objective insight and a critical eye against unnecessary testing.

When the patient was discharged from hospital, he or she would return to the primary care physician, who had kept abreast of what transpired at the hospital.

This model provided a "continuity of care" that today's health care system can only dream of. As a result of this close patient-doctor relationship, we easily identified the social and economic challenges these patients faced, and we were the physicians best able to address them given the resources available at the time.

All of that is gone. It started with the introduction of "hospitalists" — physicians who ostensibly were made available to follow patients more closely in the hospital, but who in reality represented an extension of the hospitals' attempts at patient (and revenue) control.

Primary care physicians like myself protested, but with little success. And as a result we were eliminated from caring for our patients in the hospital.

Then came the establishment of outpatient, hospital-owned ambulatory care offices, whereby these same hospitals can extend even further their grip on patient flow by effectively eliminating independent practices in the very communities where their services are needed.

And now Ms. Hahn and Mr. Reisch suggest hospitals need to do even more. I say they have already done too much. This is not just my personal opinion; even the American Medical Association has editorialized about the necessity of maintaining independent medical practices as an integral part of a properly functioning health care system.

I suggest the authors go back and do some more research.

Dr. Paul T. Barbera

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