What’s it Like Being a Colorado Hospitalist?

An Interview with Dr. Chris Meinzen

Image courtesy of Dr. Chris Meinzen

Dr. Chris Meinzen was raised in Kansas and Nebraska, and moved to Grand Junction, Colorado to enjoy life in the mountains. He earned a bachelor’s degree in creative writing and neuroscience at Tulane in New Orleans, followed by working at the Red Cross, and eventually by medical school also at Tulane. After graduating, he completed a year of research with Johns Hopkins Infectious Disease group in Peru. This experience showed him both how fortunate we are here as well as how resilient the human spirit can be in poverty. He then returned to the US to complete St. Mary’s Family Medicine Residency. He has been impressed by that same resilience of the people on the Western Slope, and was happy to remain as a hospitalist at St. Mary’s Hospital.

What is the difference between being a hospitalist and a Primary Care Physician or ER doctor?

There are a couple ways to characterize doctors these days. One is by specialty, which is to say which board certification you take. I, for example, am a family medicine doctor, because I take the family medicine board exam and maintenance of certification credits there. There are boards in cardiology, general surgery, ophthalmology, etc. Another is by what you do with this. Similar to how you can be a cook, and do that in a home, or a restaurant or on a cruise. I practice in hospital medicine, so am called a hospitalist, because that’s what I do. Hospitalists are the primary doctors for the sick who are too ill and have to remain in the hospital. Primary care physicians (PCP) can be family docs or pediatricians or internists, but who regularly see people who are generally well, and aim to keep them that way. In the past, a person’s PCP would manage their care in the hospital as well as outside it, but this is much less common now. ER physicians, which I do occasionally, though there are also a couple different boards for, take care of people who have some kind of emergency, and help decide if they can take care of that or if those people need to be admitted to stay in the hospital.

What does a typical day look like for a hospitalist?

Most hospitalists do shift work, which is to say you show up for your shift and work until it’s done. Ours is 7am to 7pm, though there are obviously night shifts for patients who come in at night or have problems overnight. First, I show up, I check my list of new and remaining patients. I then plan the day, quickly deciding who is really sick and needs to be seen right away, who may go home and can be seen next, and who likely had ongoing problems and can be seen later. I then review all their blood work, vital signs, blood sugars, and x-rays or imaging, and notes from consultants and nurses. I visit each patient’s room, talk to them if they’re able and their families when those are involved. I wrap up that patients visit by writing my orders for what will happen that day, and document a note of my thinking so everyone knows, and also so insurance will pay us. All the while I’m getting pages from nurses, other doctors, and the ER about new issues or patients to be seen.

What is the most rewarding part of your work?

The best part for me is watching people get better while we treat them. They come in with a bad problem and we make it better. I’m mostly guiding what that looks like, and a lot of the actual doing is RNs, CRNAs, PTs, RTs, pharmacists or sometimes surgeons. That’s part of the reward too, is being a part of the team.

What are some of the challenges you face day to day?

Well, some problems don’t get better. Part of my job is breaking bad news, maybe an infection won’t heal, or we found a cancer, or a patient won’t recover from a stroke. That can be emotional, even for a family I just met. Another common frustration is feeling like I have to hurry. We often have 20–30 minutes for the entire care of a patient, which may sound like a lot, but actually isn’t much time to gather the information, diagnose the problem, convey that to a patient and family, discuss a plan, and set that in motion.

How do you recharge?

I like reading, meditating, biking, climbing. Probably the most fun these days is getting outdoors with my daughter and wife.

What should patients know about hospitalists?

It can be hard to see in the bustle, but I want patients to know that we do care and we do understand. It’s natural to feel jilted by a quick visit, and that’s all too common. I wish our system gave us more time, but I think if most people had to choose, I think they would probably want their doctor to know what’s going on and give a good plan for getting better. Unfortunately that doesn’t leave as much time for empathizing or connecting on a more personal level, though people should probably know that doctors in general want that too. It’s just unfortunately quite time limited.

Do you see any trends associated with hospitalists in Colorado and/or across the country?

Hospitalists are really taking over the care of sick people. It’s a new trend, but appears to be the majority of the workforce now and keeps growing. There’s also a lot of burnout. I think the time pressure is a lot of that, lack of connection, and probably quality metrics that can feel unrelated to patient care.

Does your practice of hospital medicine seem sustainable?

That’s a good question, and hard to answer. On an individual scale, the burnout makes it hard for many doctors to sustain for their whole career. I don’t currently feel that way, but I’m not fundamentally different from many struggling doctors out there. From an economics perspective, I think a lot of our healthcare is really expensive, though I’m no expert in that. In the middle, I think many hospital systems are struggling to find a financial and ethical balance between the care you want to give, what resources are available, and a volatile healthcare system with a lot of stake holders. So, I’m not sure we’re functioning ideally to help people thrive on many levels, but I do think it’s a field where many people are striving to make it better.

What challenges in the fields of medicine and public health do you see over the next decade?

In the US, healthcare is the most expensive and the outcomes aren’t great compared to other countries. That makes it both a painful point as a country and for many individuals, but also ripe for innovation. I really applaud my public health colleagues for looking at how to improve our living generally to help a lot of the preventable diseases that we have as Americans. I’m thinking of heart disease, stroke, blood pressure, diabetes, inactivity, and social isolation. We need some big system changes to make it easier and more normal for people to live healthier day to day.

Do you see any promising solutions to those challenges?

The science of medicine is humming along, finding baby step improvements in managing disease. I think bigger solutions have to change the system though. There are some urban design projects that have impressed me. We have some bike lane and trail systems locally that I love. Nationwide there are a lot of cool examples of integrating nature, walking, or multi-use areas into existing cities. I’m impressed and a bit jealous of some of these. Some technologies for encouraging interaction and activity have been great, but I think there’s a lot more possibility still out there.