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
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