I don’t usually talk about work, but the muse awakened me at 6:30 am with some thoughts.

I felt proud to be a physician this past weekend.  I was invited to facilitate a medical staff retreat for a mid-size community hospital.  The theme was “Challenging the Status Quo.”  My formal talks included “Interdependendent Healthcare: Moving from Me to We,” and “Medical Staff Models for A Sustainable Future.”

What made me proud was listening to physicians discuss the Medical Staff President’s suggestion that all consultations to fellow physicians be initiated with a phone call in addition to an order in the chart.  His reason came from the number of medical errors and near misses due to miscommunication that he had heard discussed in Medical Executive Committee (MEC) since he became an officer. 

The reason this policy should apply to all physician-physician consults and not just stat or urgent consults is that, by asking for a consult, we admit that we don’t know what to do for a patient.  What may not be urgent to the physician who initiates the consult may be urgent to the specialist who is an expert. We should try to avoid at all possible hearing, ‘I really wish that you had contacted me earlier.  The patient would have done better.’

Objections to this suggestion came from about 5% of the medical staff in attendance.  They ranged from inconvenience and no time to physician autonomy and “we should not be telling otherwise qualified doctors how to practice medicine.”  There were also hypotheticals re: getting called at 2 am with a routine request because it was ordered during the night shift.

I commend the Medical Staff President for taking a stand and asking for a motion from the physicians to take back to the MEC to require that all consults to physicians be initiated with a phone call from the requesting physican to the consulting physician or to that consultant’s office.  I applaud the way that he listened to physicians’ comments, validated their concerns, and redirected the discussion from physician convenience to patient outcomes. 

He is a true physician champion, as described in Collaborative Champions.  When he said, “If even 20 physicians start calling in consults to fellow physicians, we will be off to a good start,” I thought of the story about the boy who threw starfish back into the ocean.  When an adult challenged him with, “Look at all the starfish stranded on the beach.  What you are doing can’t possibly make a difference,” the boy threw another starfish back into the water and calmly replied, “It makes all the difference in the world to that one.”

What do you think?

• What courageous acts of leadership have you witnessed at your organization to improve patient care
• Can physician-physician dialogue improve clinical outcomes
• Is the tide changing

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn
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