Meet Jae Kim, MD. A board-certified internist with St. Jude Heritage Medical Group, Dr. Kim, 35, works as a hospitalist at St. Jude Medical Center in Fullerton. His service is limited to hospitalized patients under St. Jude Heritage Medical Group's brand-new Department of Inpatient Medicine launched in August 2006.

As a hospitalist, Dr. Kim's worries beyond providing excellent patient care are few. Unlike physicians in private practice, he has no medical office to manage, no overhead to control and no staff conflicts to mitigate. His day is devoted to the critical medical management of inpatients, providing continuity of care and communicating with colleagues inside and outside the hospital.

The work pace is steady, with enough activity to fill--not overflow--the hours. After all the urgent needs of patients are met, Dr. Kim has time to sit down for lunch and even time to check on his own family. In fact, he has more time than ever with his family because of the generous seven days on/seven days off schedule. Dr. Kim's balanced approach to medicine is well defined and well contained.

Southern California Physician joins him Wednesday, Sept. 20, 2006:

Before work--After resting from my previous 12-hour shift, I leave the house about 6:30 a.m. to arrive before 7 a.m.

6:50 a.m.--Winding my way through St. Jude's first floor hall to the recently established hospitalist office, I meet Stephen Yoon, MD, the hospitalist on duty overnight. That's a tough shift, because the whole patient census is his to worry about. No worries, however, he says he had a good night.

7 a.m.--Because I'm the lead hospitalist today, Dr. Yoon briefs me on any cross-coverage issues. Having that information enables me to inform the other four hospitalists on the day shift with me.

7:08 a.m.--Everyone's here. Our morning meeting gets us prepared for the day. As the lead, I share the download from Dr. Yoon and carefully assign the patients. For continuity, each of us resumes care for the patients we saw the day prior.

Once everyone's patient census is decided, I tell our administrative assistants so they can arrange our internal communications. Each of us carries a pager and a hospital cell phone so if someone wants to reach the hospitalist for Mr. Smith, for example, we get the page or call directly. Providing access to a physician immediately is a big benefit of having hospitalists on site.

The assistants also give us a list of our patients, their room numbers and other basics. This paper serves as a map for my day: I keep it folded in my pocket at all times. My handheld computer is also essential. I carry it everywhere so I can reference patients' electronic charts, test results, medication lists and more.

7:36 a.m.--On the elevator to the third floor, I refresh my memory about my patients by looking at my census. I decide to start with a new patient admitted overnight.

Although the patients are often different each morning, the challenge is the same. One of the most difficult things hospitalists deal with is the fact that the patients don't know us. We get the same questions: "Who are you? Why are you here? Where's my doctor?" We have that first 15 minutes to gain patient trust.

I take as much time as necessary to explain my role in their care and how I will be working closely with their physician during their hospital stay. I also take time to introduce myself to family members. One of the most positive aspects of being a hospitalist is spending time with patients' family members, answering their questions and alleviating their fears.

7:53 a.m.--I see a patient awaiting orthopedic surgery. Her nurse catches me in the hall and wants me to talk about pain management. The patient has refused all pain medication. To reassure the patient, I explain: "Don't be afraid of pain medication. You will need it especially after surgery. We don't want you enduring any pain."

8:46 a.m.--It's a busy morning, and I get calls to handle five admissions, two from the emergency department and three from the intensive care unit. I assess the patients briefly before assigning their care to the other hospitalists on duty with me. We try to keep the census equal so the workload is even among us, which enables us to provide the best possible care.

10:10 a.m.--Back on the third floor, I visit a patient with an infection. After a night of IV antibiotics, the patient is doing better and sitting up. Because he's smiling again, I tease: "Boy, you look a lot different when you're vertical as opposed to horizontal. Vertical suits you." We discuss my care plan to keep him in the hospital one more day and arrange for physical therapy at home. I work on continuity of care issues during our case manager meeting at noon.

10:30 a.m.--Dasani strawberry-flavored water is my new favorite drink. I grab a bottle from the cafeteria, take a minute to stand still and think about the progress of the morning.

Hospital medicine feels right for me. I gravitated toward the acute care setting. I have been a hospitalist for four years, and I think more physicians will be taking this route. Hospital medicine is a burgeoning field, and everyone agrees that it is a valuable medical specialty to closely manage hospital patients. Primary care physicians who are so busy trying to maintain an outpatient practice are glad to have help with inpatients. Doctors in our community feel confident about our services.

Hospital administrators seem pleased with the program, too. They are motivated to keep doctors in house 24/7. St. Jude Medical Center is focused on providing top-notch, thorough and comprehensive care because of quality measures like Leapfrog.

11:40 a.m.--My pager goes off. It's Miho, my wife, which means it's urgent. I take a quick break to call her. Our son, Lucas, has been sick, so she took him to the pediatrician. Diagnosis: An infection in both ears. His illness is not terribly surprising considering we just spent several days in Las Vegas with a group of five families. I guess the kids swapped some germs along with their toys.

The Vegas trip and other vacations are possible because hospital medicine affords me a great life-work balance. It's shift work, so I'm really off when I'm not at the hospital.

11:50 a.m.--I'm back on the floor to see a patient. Before I go in, I pull up her most recent labs on my laptop. Her white count is improving, but her blood pressure is still low. She looks better and is more alert, but she is going to be in the hospital for a while. "I'll see you again soon," I say.

12:03 p.m.--I jet down the hall for the daily meeting between the hospitalists and case managers. Seven case managers and five doctors gather around a long table to discuss the status of each patient in the hospital, communicating everything from therapeutic needs to insurance information. The case managers help us organize discharges and appropriate posthospitalization care.

As my colleagues discuss their patients, we hear about the range of conditions being treated--stroke, GI bleed, scrotal pain, prostate cancer, MRSA and end-stage renal failure just to mention a few.

12:25 p.m.--It's my turn. I share details about the services my patients need, including follow-up appointments with their primary care physicians, transportation services, physical therapy, home health and social services. I always feel better after these meetings because I have a level of assurance that my patients will get the care they need outside the four walls of the hospital. This essential collaboration with the case managers delivers excellent care.

12:40 p.m.--I head to the cafeteria for lunch with three of my colleagues. So we can be at our best for our patients, we consciously carve out time to eat during our 12-hour shift. We have a built-in rapport because eight of the 12 hospitalists in our group trained together at LAC+USC Medical Center.

1:45 p.m.--Another patient was admitted from the emergency department while we were at lunch. That makes seven admissions today. I give the case to Dr. Hanuman.

1:55 p.m.--I head up to the rehab floor to see several patients. First, I carefully assess the medical condition of a patient who had a hip replacement. We discuss how to make her more comfortable with the rehab process.

2:20 p.m.--I'm concerned about a total knee replacement patient's complaint about chest pain. To deliver comprehensive care, I order all the necessary tests and a cardiac consultation.

2:40 p.m.--For a rehab patient who's about to be discharged, I talk about arranging home health services. I ask, "Do you feel strong enough to go home?" Her answer isn't very convincing. "We are going to make sure you get some help. You are not alone."

3 p.m.--Computer work is next. I've seen all my patients at least once today, so I can do my billing and office work. I'll check on many of them again in a few hours, but for now it's just me and the keyboard.

Everyone jokes around that doctors spend more time doing administrative work than we do taking care of patients. There is certainly some truth to that. But with this computer program, I can get through the process fairly quickly now. My paper patient census is nearby as I work though my billing. In total, I bill for 16 patients and two admissions today. Double click: Save. St. Jude Heritage's medical billing staff will review my files before sending the claims for payment.

3:20 p.m.--With billing done, I check for e-mail. Among other things, there's a message about a conference I'm attending to learn about the latest upgrade to our electronic medical record system.

3:30 p.m.--I use the EMR program and electronically sign a slew of charts and orders.

3:41 p.m.--A nurse calls. The lab report for one of my patients shows she has a urinary tract infection. My order: "Start her on Levaquin 500 mg IV, and ask the lab to do a culture and sensitivity on the urine." Being able to respond to lab reports immediately is a critical service that we hospitalists provide.

4:05 p.m.--Timely communication with patients' primary care doctors or specialists is a priority, so I dictate my H&P and discharge reports. We have to make sure doctors in the community can confidently provide ongoing care, so they must know what happened in the hospital as soon as possible.

5:03 p.m.--On the topic of discharges, I arrange for four patients to go home. Hospitalists can make hospital care more efficient. We identify all the problems, coordinate getting the right specialists on board, resolve the acute issues and then discharge to follow-up care. It can be difficult for outpatient physicians to manage the minute-by-minute care needs of inpatients.

5:47 p.m.--The floors are filling up with family members. I get involved in a lengthy discussion with one family regarding end-of-life issues. The whole situation is a reminder that hospitalist work means I deal with death and dying daily. It is a sobering reminder of our role in medicine.

6:10 p.m.--My next family conference is more positive as I can relay how much better their father is doing in the Transitional Care Center. He will be going home in two days.

6:35 p.m.--The five of us on the day shift meet to review notes and highlight important info for Dr. Yoon, who is coming in shortly. Dr. Yoon and I will repeat our one-on-one meeting when he arrives at 7 p.m.

7:10 p.m.--Leaving the hospital, I feel good about the care I provided. I like working with this level of acuity. Daily, I'm able to see dramatic improvements. Patients come in very sick and leave feeling better. My personal satisfaction comes from being able to make an immediate impact in patients' lives--and still enjoy my own. I'll be home in 20 minutes, just in time for Lucas' bedtime story.

BIOGRAPHY
Jae K. Kim, MD

Birthplace: Seoul, South Korea

Current Residence: Yorba Linda

Board Certification: Internal medicine

Undergraduate Degree: UC Irvine, B.S. Biology, 1995

MD: Temple University, 1999

Internship: LAC+USC Medical Center, 1999-2000

Internal Medicine Residency: LAC+USC Medical Center, 2000-02

Practice History: St. Jude Heritage Medical Group, 2006-present, and Chest & Critical Care Consultants, 2002-06.

Language Skills: Fluent in Korean and medical Spanish.

Memberships: American Medical Association and an applicant to the Orange County Medical Association.

Memorable Quote: "I want patients to know we exist." His reference is to the public's lack of knowledge about the hospitalist trend. It can make gaining patient trust difficult sometimes.

Work Schedule: Seven 12-hour days on, followed by seven days off. Night shift once every three months.

Newest Credential: Holds a Disneyland Annual Passport. Given the benefit of having 14 days off each month, Dr. Kim can enjoy going to the theme park with his wife, Miho, and his 2-year-old son, Lucas, on a weekday.