When the clinical outcome is not moving in the direction and within the time frame that you are anticipating, it is time to consult a colleague.
Show empathy. Perhaps the most important advice is to show empathy for patients who have experienced complications. Let patients know that you can appreciate and understand their pain and suffering. Make sure you spend more time with patients who have complications, rather than less. Make an effort to answer all their questions and the questions of their families, but only if they give you permission to do so. Be very available to these special patients, and be sure to return their calls in a timely fashion.
Be forthright. As a resident rotating through pathology, I lost a patient's prostate biopsy specimens down the drain and was unable to recover them. I called my professor, Herb Seybold, MD, and explained what I had done. He told me to meet him in the hospital, and we went to the patient's bedside. Dr. Seybold was forthright as he told the patient the specimen had been "misplaced," and we would need to repeat the procedure. He also went to the administrator of the hospital and to the anesthesiology department and asked them to write off the extra expenses that would be incurred by repeating the procedure.
Provide an explanation. Make an effort to give patients and their families reasons for complications. Of course, this can be done without admitting guilt, but take responsibility for the problem and provide reassurance that you will help the patient through the problem.
Inform your staff of the situation. Let your staff know the situation with the patient. Make sure staff members give the patient the appropriate kindness and access to you when he or she calls the office. When he or she needs an appointment, make sure the staff provides ready access to the practice.
Ask for advice. Knowing when to request another opinion requires a bit of a sixth sense. Certainly, when the clinical outcome is not moving in the direction and within the time frame that you are anticipating, it is time to consult a colleague. The advantage of another opinion is that you are in control of the situation and the patient is not finding an opinion that may not only be useless but potentially counterproductive. You also have control over the communication process with another colleague and can call the patient and provide pertinent clinical materials such as radiographic studies, lab reports, and operative notes.
When the patient requests a second opinion, there can be a dearth of communication between you and the consulting urologist and a level of discomfort when they send you a release of records form. Make every effort to stay in control, and if you sense the patient may want a second opinion, proactively suggest it and find the appropriate colleague to consult on the case.
Be a gentleman/gentlewoman. Never, ever disparage another doctor's management of a case, even if you disagree with their handling of the situation. By saying, "I can't believe they did (or didn't do) that," you are sowing the seeds of doubt into the patient's mind and may have started the process of lawsuit against your colleague. As a result, you may be called as a witness in court or in a deposition against your colleague, which would certainly lead to intense friction between the two of you. Remember, what goes around comes around. And if you forgot that adage, remember, "There, but for the grace of God, go I!"
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