The traditional patient–primary care physician (PCP) relationship
provides many ethical protections for patients, including confidentiality,
shared medical decision making, and respect for patient autonomy. Hospitalist
models, which introduce a purposeful discontinuity of care, threaten these
protections and raise certain ethical concerns. We analyze 2 cases that explore
ethical issues arising in hospitalist systems and suggest ways to ensure ethical
protection for patients. The first case examines how hospitalization can disrupt
the patient-PCP relationship and raise ethical issues regarding confidentiality.
In the second case, we discuss decision making when the patient's goals and
preferences for care change as a result of hospitalization. Effective hospitalist
systems provide a model for a trusting patient-physician relationship. Although
the hospitalist must take responsibility for inpatient management, the PCP
has a key role in addressing important issues in the hospital and providing
care after discharge. As hospitalists assume control of inpatient care, they
must also provide ethical protections to patients to supplement those currently
vested in the patient-PCP relationship. An approach that keeps the patient's
best interests foremost, defines a clear role for the PCP, and takes advantage
of the expertise and availability of hospitalists will best serve patients
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 36
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Care at the Close of Life: Evidence and Experience
Moral and Legal Framework
Users' Guides to the Medical Literature
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.