Curbside Consequences


Question: I’m a hospitalist in a small hospitalist group, so I stay pretty busy and sometimes I have to turn away a lot of requests for help. Recently I did a curbside consult on a surgical patient with diabetes. It was a hectic day, as usual, but I made time to do it because, to be honest, I’m very interested in these kinds of cases (for personal reasons). Problem is, another physician saw me give the consult and then asked me to do one for him about an hour later ... and I said no! I felt bad, but honestly, I had several patients to follow up with and felt I had to press on. I feel like I might have damaged my relationship with this doctor (a cardiologist). How can I help rebuild our relationship?

Boo-Boo in Beloit, Wis.

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Dr. Hospitalist responds: Dear Boo Boo: Feel like you worked your way into a pile of doo doo? I generally go by the rule that if I feel something went wrong with an interaction, something probably did and damage control is in order.

Ignoring the encounter may lead the cardiologist to believe that you don’t value your relationship. I suggest you explain your predicament to the cardiologist and let him/her know that you are addressing problems with your schedule. To fix this “problem,” you need to examine why it occurred and understand how you can prevent it.

If you feel like you are “turn(ing) away a lot of requests for help,” I suspect you are missing a significant amount of business. You can view this as a problem or view this as an opportunity. Also recognize this is an opportunity for competitors. Referring physicians will send referrals elsewhere if you are not able to consistently provide the necessary service.

What’s not clear to me is whether your inability to accommodate requests for referrals is due to inadequate staffing, inefficiency, inappropriate billing, or a combination of factors.

To elucidate this situation, you need data. You will never know the facts until you gather the data.

If you are not measuring your program’s performance presently, it is never too late to start. Begin by tracking your work relative value units (wRVUs). This is a commonly used marker of productivity. SHM’s biannual productivity and compensation survey benchmarks this data. Are your wRVU data comparable with hospitalists with similar job descriptions? If so, consider adding staff to your program. If your wRVU data fall short of expectations, does the problem lie in billing? Are you billing for each encounter? Are you billing at appropriate levels for service provided? An audit of your notes and bills can be insightful. Or is inefficiency contributing to your problem? If so, consider an examination of your workflow. A workflow redesign with implementation of tools like templates may markedly improve your efficiency.

Career, Committee Work

Question: My career growth is very important to me. I’m presently the only hospitalist in our program, which I started about a year ago. I have many requests to serve on hospital committees. I’ve tried to serve on as many as possible but feel overstretched. Should I stop serving on committees and concentrate on my clinical work? Would this be bad for my career?

Too Busy in Ohio

Dr. Hospitalist responds: Dear Too Busy: Kudos for taking your job seriously, but don’t feel like you have to serve on all committees. Your concern about burnout is legitimate. There are many reasons hospitalists serve on hospital committees.

Seats at the table of some committees clearly have a higher potential impact than other committees. Participation in some committees can foster relationships with other hospital leaders and better position you and your hospitalist program. Others serve because committee participation may be tied to financial remuneration. I suggest you serve on committees where you believe you can be of most benefit to the hospital and for your program.

Ask yourself, “Does the committee work fit with the goals of the hospital or hospitalist program?” I always remind folks that they should not just think of committees as a way to get paid or better themselves. Some of the most meaningful work comes from serving on committees where members make difficult decisions and often sacrifice their individual goals for the betterment of patients and families. Consider limiting your participation to certain committees. Pick wisely, and you may find that you will cherish your participation.

An Unfortunate Encounter

Question: About a week ago, I was rounding with our CEO and a visiting doctor who is a friend of his. The CEO likes to tag along every so often to stay in touch with ‘‘the trenches.” At one point, they witnessed as I conducted a hand-off. I keep apprised of my peers’ discussions on how to do a proper hand-off, so I was following what I think is a pretty sound checklist of steps.

Unbelievably, my CEO’s doctor pal began ‘‘whispering’’ comments to the CEO about how he thought such and such I was doing wasn’t entirely necessary. (I could hear them clearly, as could the physician to whom I was handing off the patient, and the patient herself!)

I happen to know for a fact that the CEO has mused aloud and behind closed doors about the value of our hospital group. I’ve heard him, and friends have told me they have, too. I feel as though he’s undermining our efforts to adhere to a sound hand-off routine. How can I try to make him understand the value of a sound hand-off plan? Even if I can’t, how can I get my peers to buy in to better hand-off rules?

Angry in Helena, Mont.

Dr. Hospitalist responds: Dear Angry: it is laudable that your CEO makes hospital rounds. More CEOs and hospital administrators should do the same. Whether they are to “keep in touch” or for the appearance of doing so is probably less important. Inevitably they will see things on rounds that will help them understand the challenges doctors and nurses face every day in the hospital.

I share your concern that a colleague—but more importantly, a patient—heard your CEO’s friend make derogatory comments about your work. Although your CEO has made public comments previously about the value of your hospitalist program, he missed the boat on this one. He had a great chance to show you, your colleagues, and your patient how much he values the care you and your colleagues provide.

It may very well be that your CEO did not feel like his relationship with his friend could stand the conflict, but I am concerned that his lack of action may have created irreparable damage to his reputation as a leader. I have seen interactions like this breed gossip, which spreads like wildfire. Soon thereafter, discussions of the situation may bear little resemblance to what actually happened.

Make an appointment to meet with your CEO and describe to him what you saw, heard, and felt. Any smart CEO will understand that aside from an explanation, an apology is in order—if not to appease you, then to save his reputation as a leader. TH

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