By Carol Harbers

As a pediatric hospitalist at Duke Children’s, Heather McLean, MD, says that she likes being a constant presence, always there, to help families in crisis. But she not only helps families. As a hospitalist, McLean and others like her provide the inpatient primary care physicians are no longer finding possible.

Hospital medicine emerged in the United States in the last ten years or so in part because of the logistical difficulties for primary care physicians to keep up with inpatient rounds. As cases became more complex, especially at places like Duke Children’s, the need for the specialty was underscored.

Heather McLean, MD “Thirty years ago kids were hospitalized for tonsillectomies and mild pneumonia,” says McLean. “Today we’re seeing sicker and sicker patients. The hospitalist develops inpatient skills, and we’re more available for safety purposes and supervisory training.”

A hospitalist will have various responsibilities, depending on the hospital. “All provide inpatient care, but at Duke Children’s we’re a bit different in that we provide sedation services, have the academic responsibilities, and work on research and quality improvement projects,” says McLean.

Despite these differences, McLean says her job at Duke has one overriding similarity to hospitalists everywhere: communication. McLean says she works to stay in contact with pediatricians at admission, during the patient’s stay, and at discharge. She uses “family-centered rounds” to make sure the family is involved and informed. “Communication is always a challenge for everyone at every hospital,” she says.

McLean says that as Duke Children’s increases its capacity, including more beds in the intensive care unit and a new low acuity surgical unit, the role of hospitalist will be even more important in the future.