Conflict Resolution & Consultative Medicine
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Transcript of Conflict Resolution & Consultative Medicine
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You receive an angry page from one of the discharge planning nurses. She has been
asking your intern for the discharge paperwork for this patient since yesterday, and is furious that the intern has been rude
and dismissive. She wants you to “deal with it”. There have been “issues” with
this intern before…
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Conflict Resolution & Consultative Medicine
Chad Vokoun, MD
UNMC – Internal Medicine
Associate Program Director
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Conflict Resolution:The Role of the Chief Resident
• The chief resident has a unique position- EVERYONE will come to you with issues (real or imagined) for you to fix – residents, nurses, faculty
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Conflict Resolution:The Role of the Chief Resident
Chief Resident
Patient Advocate Resident Advocate
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Conflict Resolution:A Survival Guide
Rule #1: Always get the whole story
Rule # 2: That means a first hand account of ALL sides, if possible
Rule # 3: Identify the “real issues”
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Conflict Resolution:A Survival Guide
• Not every battle has to be your battle
• Do not confuse “venting” with “real issues”
• Take notes
• BE FAIR
• BE CONSISTENT
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Conflict Resolution:A Survival Guide
• Listen
• Listen
• Listen
• Don’t take sides
• It’s usually a communication thing…
• “Do the right thing for the patient”
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AMA Ethical Principles of Consultation
• One physician should be in charge of the patient’s care.
• The attending physician has overall responsibility for the patient’s treatment.
• The consultant should not assume primary care of the patient without consent from the consulting physician.
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AMA Ethical Principles of Consultation
• The consultation should be done punctually.• Discussions during the consultation should be
with the referring physician and only with the patient by prior consent of the referring physician.
• Conflicts of opinion should be resolved by a second consultation or withdrawal of the consultant; however, the consultant has the right to give their opinion to the patient in the presence of the referring physician.
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Ten Commandments of Effective Consultation
Arch Intern Med 1983
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Ten Commandments of Effective Consultation - I
• Determine the question
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Ten Commandments of Effective Consultation -II
• Determine the urgency
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Ten Commandments of Effective Consultation - III
• Look for yourself
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Ten Commandments of Effective Consultation - IV
• Be brief
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Ten Commandments of Effective Consultation - V
• Be specific
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Ten Commandments of Effective Consultation - VI
• Provide contingency plans
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Ten Commandments of Effective Consultation - VII
• Honor Thy Turf
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Ten Commandments of Effective Consultation - VIII
• Teach with tact
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Ten Commandments of Effective Consultation - IX
• Talk is cheap but effective
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Ten Commandments of Effective Consultation - X
• Follow up
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Curbside Consultation
• OK for general questions
• OK for education
• Caution with specifics
• Medical-legal implications
• Document