If this post were solely about bad reporting, the linked story would keep a journalism class busy for a week. An incomplete narrative, with hearsay, and little illumination for the lay reader on standard hospital physician interaction make for compelling reading…if you enjoy fiction.
Unfortunately, this story is real. Painfully so, and as I read it, my mood soured. Not because I suspect malfeasance—that will take a day in court and hours of depositions, but because the public is refereeing the participants and prematurely rendering verdicts before the facts are unearthed and judged in the appropriate forum. Shame on them!
However, what is principal are the issues that this case will raise, mainly, the “risk zones” that hospitalists venture into when engaging with specialists and community based doctors.
Allen Kachalia MD, JD runs the Legal Consultation: Risk and Mitigation Strategies session at SHM Annual (which I never miss, and is exceptionally good), and without fail, participants ask these questions every meeting:
- Where does my responsibility begin and end via the PCP?
- Who is responsible for carrying out orders, the consultant or me?
- Must I address every suggestion a physician places in the chart?
- As compared to ambulists, i.e., as a “hospital specialist,” do the courts hold us to a different standard of care?
- Can my employer base compensation on LOS reduction?
If these resonate with your experience, read on and render your own judgment. This case touches upon them all, and reflects a reality we must accustom to as our specialty matures. It will also leave you with an unsettled reaction, and not of the warm and fuzzy kind.
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.