Hospital Patients are More Complicated Than Ever: What It Means for Medicine

Let’s face it. The practice of Medicine is just harder now.

The first time I saw a patient in the hospital was in 2004, twenty years ago, when I was a third-year med student.

Since that time, I have spent countless hours in the hospital as a resident, a renal fellow, and finally as an attending. And I’m sure many of you in the medical community feel the same thing I do — which is that patients are much more complicated now than they used to be. I’ll listen to an intern present a new case on rounds and she’ll have an assessment and plan that encompasses a dozen individual medical problems. Sometimes, I have to literally be like — wait, why is this patient here again?

But until now I had no data to convince myself that this feeling was real — that hospitalized patients are getting more and more complicated, or that they only seem more complicated because I’m getting older. Maybe I was better able to keep track of things when I was an intern rather than now as an attending, spending just a couple months of the year in the hospital. I mean, after all, if patients were getting more complicated, surely hospitals would know this and allocate more resources to patient care, right?

Right?

It’s not an illusion. At least not according to this paper, appearing in JAMA Internal Medicine, which examines about 15 years of inpatient hospital admissions in British Columbia.

I like Canada for this study for two reasons. First — their electronic health record system is province-wide, so they don’t have issues of getting data from hospital A vs. hospital B. All the data is there — in this case more than 3 million non-elective hospital admissions from British Columbia. Second, there is universal healthcare. We don’t have to worry about insurance companies changing, or the start of a new program like the Affordable Care Act. It’s just a cleaner set up.

Of course, complexity is hard to define, and the authors here decide to look at a variety of metrics I think…