Patients admitted to hospital in the past few months will have noticed a change.
Instead of the familiar face of their family doctor, a reassuring presence for many, they have been confronted by a hospital doctor, who they have never met before.
It's a change which administrators say will take Bermudian healthcare into the 21st century. But not everyone's happy.
Family doctors claim they are being "squeezed out" of the hospital by a new U.S.-style system that threatens to undermine patient care.
Many GPs complain that they have effectively been forced to give up their "hospital privileges", which allow them to supervise the care of their patients once they are admitted to King Edward VII Memorial Hospital.
Some say they are not even being informed when patients are hospitalised.
They claim a breakdown in communication has led to some sick Bermudians being prescribed the wrong medication.
Donald Thomas, chief of staff at King Edward, admitted there is plenty of opposition to the new system.
At one point, he feared GPs would hang an effigy of him outside his top-floor office.
He accepted there is validity to some of the complaints and insisted the level of communication between hospitalists, which now oversee the majority of patients admitted to King Edward, and GPs, who used to fulfill that function, would improve.
But he insisted the old system was "sub-standard" and said GPs were too busy in their practices to spend enough time at the hospital taking care of patients.
He added the level of patient care had vastly improved since the introduction of hospitalists - highly trained internal medicine specialists who make daily rounds to patients under their care.
Mr. Thomas said: "Re-admissions are lower, complication rates are lower, patient satisfaction is tremendously higher, staff satisfaction is higher.
"By most of the measures we go by there has been an improvement in the level of care."
Somerset-based doctor George Shaw claims this rosy assessment is not in sync with what he is seeing and hearing from patients.
He said: "The main problem is that there is very poor communication. Patients can be in hospital and we wouldn't even know.
"We have lost the continuity of care. I know everything about the past history of my patients and I am not asked anything about them when they are admitted to hospital."
His claims were backed up by a patient who told the Bermuda Sun her seriously ill husband was prescribed medicine in hospital that his doctor had already taken him off.
She said her spouse was in and out of hospital all the time and his private physician needed to be kept up to date.
She added: "He likes to have his doctor come in and see him or at least have it known that his doctor has been notified about whatever changes have been put in place."
Dr. Thomas said he had moved to address the communication issue by introducing an e-mail/text alert system to keep GPs in the loop when their patients were in hospital.
But he believes a wider power struggle is at the root of the dispute.
He says he is determined to transform King Edward from a "cottage hospital" to a "community hospital", even if it means treading on the toes of some doctors.
The old system, where GPs and private physicians made hospital calls to their patients and supervised their care, was, he said, designed for small, village communities.
But the new system, with specialists employed by the hospital supervising inpatient care, followed the model used by most community hospitals.
"Bermudians live in a first world country - they deserve to have first world medical care. This is not a rural backwater, it is a metropolitan area.
"The care we are delivering should be up to that standard and it wasn't."
Central to the issue is the role of the hospital's 'house staff'. These are trained doctors who have completed their medical degree but have yet to complete a residency (period of tutelage under a fully qualified doctor).
GPs say the hospital's decision to deny them the assistance of these house staff amounts to a de-facto ban on them from supervising their patients in hospital.
"We have to go down to the hospital and do all that leg work without any support from the house staff. The majority of us have said 'gee. I can't do that...
"A good number of colleagues have just resigned their privileges from the hospital," said Dr. Shaw.
But Dr. Thomas stood by the decision, saying the house staff were given too much responsibility under the old system. He insisted that if the GPs wanted to supervise patient care in the hospital they would have to take on the work that came with it.
"Every doctor has the choice to continue taking care of patients in the hospital but they have to do it in the new way."
Dr. Thomas insisted the house staff needed to be under the supervision of fully-qualified doctors and were not there to do the bidding of the GPs. He claimed some GPs rarely visited their patients in the hospital, relying on the house-staff to help them do check-ups over the telephone, yet still billed insurance companies for a hospital visit.
"The level of attention to the needs of the patient was sub-standard. They can't really deny that the system was bad," he added.
He admitted that the hospital could now claim more money for consultancies from the insurance companies. But he insisted that revenue went to paying the salaries of the hospital's expanding staff and improving patient care.
Senator Jeanne Atherden said she was concerned about the volume of the complaints.
" The United Bermuda Party supports in principle the hospitalist system for its potential to improve patient care, but we believe it essential the programme proceed in a more cooperative basis, better integrating hospitalists' on-site availability with specialist treatment and GPs' intimate knowledge and understanding of patients and their medical histories. The system should be about putting the interest of patients first, not turf building."
What do you think? Send feedback to editor Tony McWilliam at tmcwilliam@bermudasun.bm
Reader Comments
Posted: Friday, October 30, 2009
Comment by:
Donna Ingham
I agree that this new system does not work and caused my family nothing but heart ache.
Posted: Wednesday, October 28, 2009
Comment by:
sharonlyn wilson
mr Mcwilliam, i dont like the fact that my doctor is not visiting me in the hospital, i have built a relationship with him and i comfortable with him. i dont like the fact that a stranger is taking care of me or my family and i would like to see this go back to the old system.
