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General Operational Topics

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Post Practice Boundaries
Author: hwellens
Date: Jul 12, 2008 9:53 am
Our Palliative Care Service Medical Director and NP both came out of the Hospitalist Service. We have struggled with consults where we see the opportunity to improve the medical care as well as pursuing palliative goals. This has lead to a "2 for 1" on surgical type referrals where the surgeon would welcome that help. However, with intensivist or internal medicine referrals it is a source of conflict. In other programs, how do you address the urge to assist with medical management? Do you keep clear boundaries, perhaps limited to the reason for referral? Thanks.
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Re:Practice Boundaries (by Weissman on 07/22/2008)
I think this is one of the most challenging aspects of hospital-based PC. There are two approaches, that are not mutually exclusive:

a) work to build individual relationships--without a sense of trust from the referring MD that i) you have something worthwhile to offer and ii) that you won't make them look bad, the consults will be hard to get. This can be especially hard for hospitalists who in the minds of intensivists, have nothing to offer them. I'm assuming your hospitalists are board certified in Hospice/Pall Med--if not, they need to be.

b) move to a system of care in which patient variables (diagnosis, prognosis, length of stay, symptom issues) drive consults, rather than the whims of the referring MD. This takes considerable political will to institute, but in the long run, is better for patients.

If you go to the CAPC home page, along the top row are buttons, click the CAPC Resources button and follow the links for Audioconference Archives-I gave two audioconfernces on consultation ettiquette last year that delve into these issues: Reaching Out to Your Referring Physicians Part: I and II.

NOTE: See the audio conference archives as referenced above at this link:
http://www.capc.org/support-from-capc/audio-conf/past-audio-conf/


David Weissman, MD
Professor & Director of Palliative Care
Medical College of Wisconsin
Palliative Care Leadership Center
Milwaukee, WI

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