Perry Wilson: Does it seem like your hospital patients are getting more… complicated?

Perry Wilson, Director, Clinical and Translational Research Accelerator at Yale University, shared on X/Twitter:

“Does it seem like your hospital patients are getting more… complicated? They are!

Just went through this paper from JAMA Internal Medicine which, like all good papers, comports with my prior beliefs. No, but seriously, I definitely feel like hospital complexity is rising.

Data comes from British Columbia – good for 2 reasons.
1) Universal EHR so you capture all hospital admissions
2) Universal healthcare – so you don’t need to worry as much about access issues, etc.

The tricky part is defining “complexity” but basically by all metrics, patients are getting more complicated. Older. More comorbidities. More medications. More time in the hospital in the year prior to the admission of interest.

Despite that, we do OK with them. 30-day mortality is stable over time. (Interestingly, less inpatient, more outpatient mortality as time has gone on – we do like to d/c people).

Why is this happening? I think the big things are
1) Demographics – older population = more complicated patients
2) Better therapies. We simply keep people alive longer now than in the past. Better cancer treatment, less invasive CV rx, better ICU protocols.

So basically the job of medicine is getting harder. It’s just harder now than it was 20 years ago. So… does it make ANY sense that hospitals are staffing so poorly? Could taking care of MORE patients who are MORE complicated lead to MORE burnout?

And maybe we should remember that a lot of the people in positions of authority in the healthcare system – even the doctors up in the c-suite – may not have taken care of patients for 20 years. They may not understand what modern medicine really looks like…

Maybe they need to spend a few days on the ward…

Sorry. Ranting. More here in my MedScape column, and here’s the primary source.”

Source: Perry Wilson/X