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Hospitalists: Crossing borders within health care institutions.

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Chesluk BJ. — American Board of Internal Medicine

Presented: American Anthropological Association Conference, November 2012

Abstract: The work of hospitalist physicians illuminates how patients and providers grapple with the fragmented U.S. health care system. Hospitalized patients and their family members can feel trapped in a liminal and challenging situation, treated by multiple uncoordinated units and teams who do not collaborate well with each other. Hospitalists are a relatively new subspecialty of physicians, tasked with coordinating patients' care throughout their hospital stay. This entails caring for diverse panels of patients across their hospitalizations, and throughout the entire hospital and beyond, attempting to coordinate and plan in the face of systems that lack tight coordination and organization. To do this, hospitalists cross physical and social borders within the hospital. As they round to track their patients throughout hospitals' diverse complex of isolated units, they develop personal networks and deep local knowledge that span the hospital's fragmented social worlds and complex bureaucracies. However, they inevitably need to work with people and institutions outside the hospital (to understand their patients’ past, and plan for discharge). Then, they often become as stuck in limbo as their patients, without inside knowledge to help, up against opaque and unfamiliar bureaucracies in insurance companies or other hospitals. Experts in crossing borders within the hospital, they must turn to their patients for help when up against the borders around the hospital itself.

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