Hospitalist Serves as “Gatekeeper” for Patient Care at Premier Medical Centers
Philip Manners, MD ’11, calls hospitalists the “gatekeepers to the hospital,” and as an attending physician at three acclaimed hospitals in the United States, he’s in a unique position to assess and implement the strengths of each department in each location.
“It’s like you’re a project manager for the patient. You really have to know how each hospital department works,” said Dr. Manners, who splits his time between UCLA Health, Cedars-Sinai Medical Center, and Johns Hopkins Medicine. “You have to look at the entire picture and view the patient as a whole. A sub-specialist can provide invaluable input very specific to their field of practice, but it’s up to the hospitalist to collect and assess all the available information, problem-solve conflicting recommendations, and unify the plan. Then the hospitalist can implement a cohesive plan that ultimately provides the most benefit to the patient.”
And in addition to his clinical duties, Dr. Manners is on faculty at David Geffen School of Medicine at UCLA and is a major in the US Army Reserve.
The native Brit shared how he juggles his responsibilities and how his role emphasizes adaptability and communication, no matter where he’s seeing patients.
SGU: What about being a hospitalist have you enjoyed most?
Dr. Manners: I like helping sicker patients. That’s not to say that I like people to be sicker, but I like taking care of people with a higher acuity that require more complex management and a higher level of care. The challenges are greater, but that’s what makes it more rewarding when you have a successful outcome and make a positive difference to a patient’s life.
Even though I trained in full-spectrum family medicine, I find the inpatient side more satisfying. You can really see the difference you make unfold in front of you. It affords you more time with the patient, whereas in primary care, there’s always a battle of time and not having enough of it. With hospital medicine, you have more breathing room to really get your teeth into the patient’s problems.
“Being able to see the difference between the three hospitals is also intriguing. In a lot of ways, the job is fundamentally the same. The medicine is the same. But the systems and processes can vary widely.”
SGU: What kind of person is best fit for a hospitalist role?
Dr. Manners: To be a hospitalist, you have to be comfortable with patients who do have that higher acuity. If they’re sick enough to be in the hospital, there’s usually a complicated mix of problems and comorbidities. Also, you must be able to adapt to situations that can change quickly. One minute you can be dealing with a patient who is stable and ready for discharge, and the next you can be walking into a rapid response or a code. There are two ends of the spectrum there. Emergency medicine is similar to this, but the main difference with hospital medicine is you get follow the patient’s journey and see the progress they make. If you like the higher acuity, and the continuity of care, then hospital medicine is probably a better fit for you.
SGU: You were at Massachusetts General Hospital when the COVID-19 pandemic began. What was your role there?
Dr. Manners: I was in the middle of my disaster medicine fellowship at that time so, on the one hand, it was great because I could practice what I was training for, but on the other, the reality of a global pandemic was terrifying. Most hospitals have a small set of rooms that can accommodate airborne isolation, and we started off using those. We were implementing similar isolation procedures like we did for SARS and MERS. With COVID though, it soon became apparent that the isolation rooms were going to run out quickly, as did the PPE.
It’s a huge undertaking to upend a hospital’s entire standard operating procedures. The hospital incident command system kicked in and we essentially had to rewrite how the hospital was going to function. The hospitalists were at the forefront of this because we were the ones who were getting the COVID patients. We ended up converting entire medical and surgical floors into COVID-only floors, and oncology rooms were converted to make COVID ICU rooms. It was fascinating to see it evolve and to be on the front line of that. It was something that you read about, and try to prepare for, but hope you never have to actually experience.
SGU: You work at three locations on two coasts in the US. How is that experience unique?
Dr. Manners: One reason that I like working in large academic medical institutions is that you have access to a large range of sub-specialty care and resources—things that are on the cutting edge of medicine. I’m humbled to be learning from leaders in their respective fields. Being able to see the difference between the three hospitals is also intriguing. In a lot of ways, the job is fundamentally the same. The medicine is the same. But the systems and processes can vary widely. By identifying the things that work well—and don’t work well—at each hospital, I can use that information to refine and improve the care I give.
SGU: How was your experience as an SGU student?
Dr. Manners: I absolutely loved my time on the island. One major benefit of going to Grenada is that medical school became your whole world. You live and breathe SGU. Your classmates become your family. You forge close friendships by going through it together, and I don’t think you would develop those types of bonds and relationships in a US or UK medical school setting.
And then in clinicals, we had the opportunity to experience a large variety of clinical settings, in a range of geographical locations, where we had different resources, different patient populations, and learned different ways to practice medicine. It enabled me to become a very adaptable and open-minded physician.
I always tell people that medical school was the best experience of my life. I would go back and do it all again in a heartbeat.
– Brett Mauser