a hospitalist i might add hospice serve physicians that put on leave do hospital work now there's been a division of labor and even in the medical profession and because of the demands placed on primary care physicians now a lot of physicians hospitalised actually our group is functioning as hospice now in kansas bird we were we just began a hospice program to take care of hospice patients many family doctors primary care doctors find it hard to manage a hospital practice and office practice now because of all the demands placed on primary care doctors from insurance companies that time demands the other issue is that many times a doctor will do as rounds early in the morning see that patient and maybe other things that transpire throughout the day that require the patient to be revisited or other tests ordered and it's hard for a primary care physician is in the office seeing patients to get all that done so it's kind of happen across the country has been a transition of doctors that now and just work in you stated or you have a physician on call and on premise most times in general hospice programs are usually board certified internist they can be family docs internist or use a hospital train so they were special take care of patients in a hospital setting and basically they can take care of the patient to meet most of their needs with the help of consultants when they when needed but also to kind of expedite the care to give improve the quality care for the patient and also condense down the care of the patient enough to stay in the hospital's long ok it might be a little confusing for the patient that made it to the hospital but you can explain to us the hospital only functions at the hospital he doesn't take over the care of the patient correct and there's good communication usually between the hospice and the primary care physician many times if there's a question about the patient's history or care will call the primary care physician get records from the primary care physician in addition interviewing the patient family but basically a patient will come into the hospital their doctor makes a decision not to go to the hospital more just stay in the office and alexa lets his patients be kept his or her patients be cared for by the hospital  the hospital then the care for that patient during their hospital stay discharge the patient the patient falls into the primary care physician with the coordination of care and fairly rapid faxing and even phone calls if necessary to let that primary care physician  transpired in the hospital so at this point at our hospital it's now available twenty four seventh's even physicians that are not on staff it's more the patient can come to the hospital i mean there's a fair number of physicians that may only go to one hospital in the area or some many now are going to know hospitals they've elected to stay in the office because especially family docs who are really good in data with a volume of patients we don't have enough primary care for physicians in the area or in the nation so the load on primary care physician primary care physician is getting bigger and bigger and because of that as well as the need to get things authorized and the other work that goes on behind the scenes they find that they just can't handle both and do it efficiently and provide the best care ok well you and i are just about the same age almost exactly maybe some few are probably you know i never heard of a hospitalist when i was a resident or even a surgical you know in terms of that all come about it probably came about it's been probably in place for a least ten to fifteen years but not so much in this area it's kind of grown gradually throughout the country but as medicine has become more complex especially the ministration of medicine the amount of time you have to spend coordinating care as a primary care physician it's harder and harder to do the traditional approach of taking care of patients the matter where they go in the hospital we're in the office so it  really has taken off probably in the past five years across the nation but even in california and other places minnesota it's probably been in place for at least ten to fifteen years in select areas so in addition to build  see a physician to train physicians daily you also have ancillary people helping you in regards to the care of the patient at the hospital yes i mean you know we still have everything available to you at the hospital the difference is a pro example would be say in the traditional approach of a primary care physician sees patients seventy m before he starts office hours at eight am well then the test make him come back at eleven am in the traditional approach that doctor may be aware that test but really has to reassess the patient can't act on that order another test or get someone else involved until the next morning when he does around the hospice is there all the time so they go back follow up on the tests such as someone with chest pain if they're waiting for a stress test then go back at three o'clock stress test is normal you can go home many other times the primary care physician they may discharge him over the phone but that may not always be the best way to really be sure that the patient understands what was wrong with them and what they need to do in the future as well as if they don't destroy the phone in the patient's it's overnight in a hospital waiting for their primary care physician to around the following day so it's both a benefit to the hospital as far as decreasing their length of stay but also in the patient as far as continuity care which they may not have gotten previously so it's not so he had been i mean the potential to lose continuity is there if there's not good communication between the hospitals and the primary care physician and that's what you have to really concentrate on is good communication and explain to the patient that we're in touch with your physician your physician will know everything that went on here when you go back and see them in the office ok if you're just tuning in stocks are tom corker he is our chief medical officer candace burke hospital thomas been at cannes for for twenty years twenty twenty one years and that's kind of grown up in the community together and we've just started developed a hospital service it can inspire if you had any questions concerns going to a number far across the screen at the bottom  we're just trying to give everybody a feel for if you come to the hospital you actually may be admitted to the service correct and there's we have six physicians that participate in the hospital service and we're there  weekends in during the day we plan to build it to a twenty four seven hospice service and there are other hospitals in the nation that and even locally that have twenty four seven services and then you're going to see that growing so patients are to see more of this in this important understand that it doesn't mean you're your primary care physician doesn't want to take care of you it's a way of trying to distribute the amount of work that needs to be done in the day to efficiently but also do it so you can so the patient can get better care right and it just seems makes it makes perfect sense as far as the things that as you said the physician solo practitioner runs in the morning he may get bogged down during the day with dozens and dozens of patients right to have patients in the meantime they're trying to authorize test for patients they saw previous days or authorize tests with insurance companies that they haven't seen or try to get medications paid for i mean there's more and more that goes on behind the scenes now in the primary care arena that makes it you know very time consuming it is hard to fit everything into one day makes perfect sense to me so if you have questions concerns want to know more about the system  fire the number across the board again also we can be loaded on the internet as almost all hospitals these days are worse dr corkery is well known in the area and certainly be happy to answer questions or one of his staff which you know thomas excellent physician in the area what's new in the practice of medicine these days already but are we seeing what's on the horizon i mean technology's always taking off i mean technology has brought us so far even the twenty one years that i've been practicing it's amazing what we can do now in medicine the number of medications we have to treat and we have to offer to give patients better quality of life but also well clearly longevity but longevity is only important if you have a good quality life and i think that's the key people of to take a large amount of medicine but if it gives you a good quality life it's well worth it we didn't have those things before so pharmaceuticals have expanded dramatically you know technologies you know being the surgeon i mean you know when you take  day stay some poor less or less some people go home the same day that's not the way used to be in you know small incision so it really technology has made a huge difference in our ability to diagnose and treat disease and provide better care for patients which  lead to patients living longer and i think for the most part better quality of life so technology's been a breakthrough a huge but breakthrough that and pharmaceutical research has been a huge breakthrough in medicine you're swanning your area of expertise is back pain injuries so forth we were talking before we got on the air about some of the things people with back pain chronic back pain very common very common i  mean i see as all primary care physicians do tons of patients with back pain and much of back pain is mechanical so i think a lot of back pain you don't always have to live with sometimes you do and that's part of deciding through seeing your doctor whether you know you need treatment whether it be physical therapy medication or you know diagnostic imaging such as m r i eyes one thing is the population's getting older we're seeing a lot of is what's called lumbar spin patients as they get older they have to generate this disease they have arthritic change which impinges on these little tunnels within those acts and it's a very common disorder in people sixty five and older as and sometimes even younger where they get chronic back inflammatories exercise physical therapy but once you are not responding to those initial steps then it makes sense to do some imaging sometimes surgery is required by neurosurgeons or surgeons there's other pain management doctors who can inject steroids epidural steroids to decrease the inflammation which can make a difference the one thing i will say about back surgery which really i think the whole concept of back surgery most people feel if you have back surgery you never get better i think you have to keep in perspective that most people have back surgery who do well and there were talk about their back again the people that don't do well talk about their back daily so the only people talking about back surgery and give life to the people that then get better the eighty ninety percent of people to get better a back surgery have no need to talk about their backs because they're moving on with their life and i think that that's kind of lost and i think most people think well back surgery never works it's not something we rush to but it can make a big difference in the quality of someone's life and how they perform i agree again if you just tuned in dr thomas corkery board certified internal medicine specialist chief medical officer can spark hospital we've touched on the hospital's program if you have questions with that would be more unhappy entertain them either over the internet or via phone at the number below we've slid into the realm of back pain who gets five where people are getting more arthritis wear and tear degenerative joint disease over the years but it's not unheard of but you know so right away when you see someone young you're not looking for spinal stenosis you're looking at mechanical causes for people to have back pain and using mechanical causes or fixable cause do you see that more in people that smoke for their batiks or over age i mean overweight or is it just i don't know i think there's probably for degenerative joint disease and and also for degenerative disc disease degenerative joint disease osteoarthritis or you know inherited or where in terror threat is there clearly is genetic factors at play a role people who are overweight clearly clamor degenerate this disease because of the weight compressing this but there's plenty of people that aren't overweight and they're dis disintegrate and basically degenerate so i think there's a genetic component i don't know if there's anything you can do to prevent it necessarily although clearly exercise keeping your back muscles strong even if you get that will be the eight some of the problems that exist as time goes on ok you know you touched on osteopenia we have a van there's a test to check for that comes the hospital mean basically in that side much bigger the old m r i eyes that were called close their eyes you'd have the machine right down on top of you and that was you know somewhat intimidating for patients so i think now the open bore you get the best of both worlds it's like an open m r i but you get better images like a closed them and i had a couple both ways and you know then bother me that was some people aren't bothered by that they put on the headphones and use it in their great fellas other people you know have a problem know and there's always met you know we can give medications to relax you before you go into an m r i regardless so you really won't care again dr tom corkery we started talking about the hospital service can spark which again twenty four seven three sixty five for the most part at the hospital if you show up you might land on this gentleman service or one of his colleagues that wrong with that you can back to your medical doc at the end of the stay with tremendous continuity i think a lot of the older folks are always worried wots cancer i'm all and i'm not going to make it so you know i think people think when they start having pain best when they're older cancer mine most of time is not cancer try to use the more so simple things that can be at least alleviate to some degree if not completely taken care of and in reverse as far as you stated the newer treatments are there any of the back pain is talked about and you  mentioned but i want to reemphasize it's only a very small portion of the population goes on to have some form of surgery correct yeah i think as the population is getting older we're seeing more that being necessary and even eighty five year olds you know if it's if their quality of life is not good you've done everything else i've seen them go to surgery and get back their quality of life so i don't think age is terming factor i think it's more has to do with how functional that patient is at the time when you're getting from that but it's always a last resort and that with some of the pain management strategies we have we can do some other things to manage pain to make them more functional even without surgery we should also bring up the fact we have some colleagues well i think we're very fortunate now because most of the physicians in washington county allegheny county of training big city hospitals they are bringing you all the expertise the big city hospitals to the community so you don't have to travel more and as you said we have a specialist on staff should you need  expert care we have that ability or the ability to transfer that's done allegheny general hospital if necessary that's right ok well tom i appreciate coming and i discussed the hospitals program if you'd like to get ahold of