Patient advocate: What do intensivists and extensivists do?

Intensivist care and extensivist care — these aren’t medical specialties you’re likely to run into very often, unlike internists, oncologists and dermatologists. But these two types of medical practices are becoming more and more important as critical illnesses and chronic conditions affect more Americans.

So today, I want to tell you more about these physicians and the role they play in the current health care landscape.

The term “intensivist” first arose in the 1950s, during the polio epidemic. A doctor in Copenhagen, recognizing the need for not only specialized care but also mechanical breathing assistance for patients, established what is considered today to be the first intensive care unit.

And the ICU is where you’re most likely to encounter an intensivist, a physician, usually an internist, who is board-certified in critical care. They care for the sickest of the sick, those suffering from critical injuries and such life-threatening illnesses as:

• Pneumonia

• Acute lung injury

• Acute respiratory distress syndrome (ARDS)

• Liver failure

• Gastrointestinal bleeding

• Acute kidney failure

The intensivist doesn’t work alone, but coordinates and guides the care given by a team of specialists, advance practice nurses, physician assistants and others. If a patient needs resuscitation, the intensivist will oversee the procedure. Palliative care is also part of their specialty for patients who have stopped treatment and want to be kept comfortable.

Today, an intensivist may work outside the ICU, caring for critically ill or injured patients in the emergency room, medical wards, post-ICU units and even through telehealth. Major hospital systems like Northwestern Medicine and Rush University Medical Center have intensivist-led teams in their ICUs.

The term “extensivist” is of much more recent vintage, coined in 2002 by Dr. Philip Sanger, a pulmonologist in Austin, Texas. So called high-need, high-cost patients make up a relatively small portion of all patients in the U.S., but they consume a disproportionate amount of health care.

“To move from generally sick to generally well, high-risk patients need something extra — more attention than a busy primary-care provider can offer and more individualized care,” he wrote.

Enter the extensivist, who provides coordinated, comprehensive care to high-need patients in an outpatient clinic after their discharge from the hospital — the goal being to avoid readmissions. In general, to be admitted to an extensivist program, a patient must have had multiple hospitalizations or ER visits in the previous 12 months

While the intensivist is hyper-focused on the critically ill or injured, the extensivist is looking to the well-being of patients with multiple, complex and overlapping chronic diseases, such as diabetes, chronic kidney disease, COPD, cancer and congestive heart failure. They become the patient’s primary health care provider, fine-tuning medications, monitoring frequent blood work, and coordinating with other specialists. Initially, patients can be seen as often as weekly.

There’s no particular certification for an extensivist, so it can be a specialist, general practitioner or nurse practitioner who has years of experience caring for such patients, working with a dedicated team of nurses, pharmacists and medical assistants. I was interested to learn that UCLA has an extensivist clinic, and it recently offered a special curriculum to medical students aimed at helping them feel less overwhelmed by high-cost, high-need patients.

An extensivist may also provide wraparound services, which can include home visits, in-office treatments (like IV fluids) and consistent contact from their care team. The overall goal is to help patients better navigate their health care, stay out of the hospital and enhance their quality of life.

In my work as a private patient advocate, I’ve often acted as an extensivist — not providing medical care, but coordinating it and being a consistent point of contact for patients and their families. It’s encouraging to me that the health care industry is latching on to this concept. Their primary goal may be to reduce the cost burden of high-need patients, but we should also see better health outcomes.

• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” available on Amazon. Frykenberg offers a free phone consultation to readers. Contact her at Teri@NurseAdvocateEntrepreneur.com.