Subspecialists write guidelines for diseases they've never really seen. Not the full disease — just the tip of the iceberg. The sickest. The most complicated. The referral cases. The hospitalist sees the whole denominator. Every COPD admit. Every run-of-the-mill heart failure. The frail, the comorbid, the ones who will... never make it into a trial. "You're seeing the sickest of the sickest — which don't represent the monolith of the disease your recommendations are now applying to." A subspecialist's clinical credentialism is real. So is their selection bias. — Dr. Anil Makam, UCSFshow more

Love anil but disagree here. Subspecialists see most of these pts outpt and follow them regularly. If you’re saying hospitalists see more COPD than pulm, that’s not true. Pulm sees lots of COPD both inpt and longitudinally outpt, which most hospitalists don’t do

Absolutely. Specialists have a narrow focus of the “didease state”, whereas primary care (or hospitalist) has the broad view. I’ve definitely observed this phenomenon - which makes complete sense. The narrower focus has its role, as does the broad view. It’s good to recognize that

Not a very good take, which can be disproven with a single condition - cirrhosis. GIs/Hepatologists address everything from acute inpatient hemorrhaging, to preventive care, cancer, frailty, cardiopulmonary/renal problems, nutrition, and more while becoming the de facto PCP.

Horrendous take.

And when we don't fit the guideline? Must be non-compliant. Or just need to 'be more positive.' ...Exhausting.

Just see the consult bro