Briefing

One of the distinguishing features of American private practice used to be the continuity of specialist care between office and hospital. Now that is changing, with the advent of the hospitalist movement, in which office based specialists hand over control of patients they admit to hospitalists (Ann Intern Med1999;130:338-42). The hospitalist is a “Mississippi river pilot, guiding the ship through the difficult local currents, but relinquishing control to the captain when the ship re-enters the ocean.” The more efficient use of time allows more effort to be devoted to guideline development and pathways of care; the downside is concerns about continuity of care.