Continuity of Care and the Role of Nonphysician Providers

Continuity of Care and the Role of Nonphysician Providers

Don S. Dizon, MD, FACP, FASCO

Apr 15, 2013

I still recall my first rotation as an inpatient attending at Memorial Sloan-Kettering Cancer Center (MSKCC). Perhaps it was the anxiety that I remembered most; that I was “in charge” of a service. Fortunately, having done fellowship at MSKCC, the system was not a foreign one, and I knew exactly where to go to get oriented—I went to Jane and Dorothy, our nurse practitioners whose full-time job was to help care for the women on our Inpatient Gynecologic Oncology Medicine Service.

During that time, I admitted Linda.* She was young, married only recently, and had been urgently transferred to our hospital with a rare cancer—metastatic gestational trophoblastic disease. As her stay went on, I would visit her and her husband after rounds, and it became routine for me to stop by her room to chat with them both before I left for the day.

After four weeks as the inpatient rounder, I rotated off service. Swept up in outpatient responsibilities, I never did get back to the floor. Yet even while I was back in my “regular” job, I found myself wondering how Linda was doing. One afternoon, Jane paged me to the floor.

“Hey, Jane, what’s up?” I asked.

“Hi Don; just an FYI—Linda is doing great and will be going home today. She wanted me to make sure you knew.”

“That’s great,” I replied, smiling. “Please tell her and her husband I wish them well,” I said.

 “I already did,” she said.

Even today, I find it reassuring that Jane was able to close this loop (and many others) for me.

No matter how much time goes by, I always have a certain sense of anxiety when my turn as inpatient attending comes up. In my current role at Massachusetts General Hospital (MGH), I am only required to do this for a few weeks a year; however, it is still daunting to care for patients admitted with little knowledge of “who” is in house, let alone “why.” Fortunately, like MSKCC, MGH has a group of exceptional nurse practitioners to help us take care of patients on the inpatient service.  

In my career thus far, I consider myself fortunate to have worked with nonphysician providers who, like Jane and Dorothy, have participated in the care of my own patients. In the inpatient seeting, it meant helping me to get acclimated to the service, patients, and their loved ones. More than that, I have also come to rely on them as a way to ensure my patients (both inpatient and in clinic) get the highest level of care we are capable of providing.

Ultimately, despite the demands on time, duties of outpatient practice, and objectives to be met in academics and beyond, physicians have an obligation to meet the needs of their patients. That job is easier thanks to the men and women who, like us, have devoted their own professional career to the care of patients with cancer. Working in partnership, we can achieve most of what all of us aim to accomplish, without sacrificing the quality care that our patients deserve. It is a model of health care delivery I have learned not only to embrace, but to rely upon.


*Identification information changed to protect privacy.


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Heather Marie Hylton, PA-C

May, 31 2013 11:36 PM

Don, thank you for your thoughtful post.  Having worked in the inpatient setting for most of my career, I can attest to the continuity of care that PAs and NPs provide in this setting and how this benefits patients.  While it is difficult for many patients to be hospitalized, the reassurance that comes with being cared for by providers who know them well can make this journey just a little bit easier for patients. I am most appreciative for the opportunity to have worked closely with physician, NP, and PA colleagues over the years to provide the best possible care to our patients.

Don S. Dizon, MD, FACP

Jun, 03 2013 7:18 PM

Heather: Thank you for the comments. I think your last statement summarized it best- we all work together to deliver the best possible care! D

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