Some months later, I heard from the lead hospitalist, who said that the meetings had proven very valuable and things had improved dramatically between the department heads. He also said they were working together to improve the way their whole groups interacted. This wouldn’t work so well everywhere, and would have failed if not for the good character of both the doctors. But I’m struck by how infrequently the formation of social ties is included in any plan to reduce physician conflict. It is valuable, regardless of which specialties the doctors work in.
Hospitals have figured this out. Most provide a doctor’s lounge where meals might be served to provide a place for socialization. Some arrange periodic retreats for physician and hospital leaders to spend a weekend in a nice setting (with some time devoted to business and ample time for recreation and socialization). Expensive “perks” like these probably pay dividends in improving culture and reducing conflict. They also might soon be a thing of the past due to cost pressures. If so, we should all think deliberately about other ways hospitals can preserve and enhance the social fabric of what is becoming a more segregated medical staff as doctors narrow their sites of care and specialty focus.
The Universal Admitter
The most effective way to eliminate disagreements in admission decisions is to have the hospitalist admit all of them—that is, make the hospitalist a universal admitter.
Some hospitalist groups are nearly universal admitters already. No, they aren’t admitting all patients, including women in labor and some others. But they do admit and serve as attending for patients with hip fractures and other trauma and surgical issues, scheduled chemotherapy patients, etc.
I’ll save of my comments about the appropriateness of hospitalists as universal admitters for a future column. But I think that it is overkill to move to that model solely to address disagreements regarding which group admits a patient.
Another way to reduce conflict over which physician group will serve as admitting/attending physician is to develop service agreements, or “compacts,” between different specialties. The idea is to create a set of clear, written guidelines or rules that determine which group admits the patient. For example, should the hospitalist or the surgeon admit?
ED doctors usually are delighted when the hospitalists and surgeons have met to create such an agreement. It could mean the end of disputes about who admits the patient. But does it?
I’ll discuss these agreements further in next month’s column, including elements that should be addressed, how to maximize compliance with them, and why they almost always fall short of realizing their hoped-for potential.
Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course.