Dr. James, Medical Director at GLC Northumberland was getting more irritated by the moment. Over the past three months, she had been getting calls about Dr. Atkinson, a new member of her attending medical staff who had not responded in a timely fashion to warfarin adjustment requests. Last week Dr. James had heard that Dr. Atkinson had “given a nurse the third degree” about a lab not being reported. Now it was Friday, and she was just informed that a patient of Dr. Atkinson’s had been admitted but could not be reached for confirmation of initial admitting orders. When Dr. James called Dr. Atkinson’s contact number, the answering service stated that Dr. Atkinson was out of town for the next two weeks. When asked who was covering, the answering service was silent for a minute before saying…”it says here to contact Dr. James.”
What should Dr. James do? Is there any way for Dr. James to have prevented this?
Hopefully you have never encountered this sort of situation. If you have, you probably know that a little communication can often go a long way. Obviously Dr. James is going to have to address a number of issues with Dr. Atkinson when he gets back in town – everything from responsiveness and coverage of patients, to interaction with staff and vacation coverage. It also may be helpful to get Dr. Atkinson’s impression of the staff and processes in the LivingCenter to identify opportunities for improvement.
We have encountered questions at times regarding what to do regarding new attending doctors. One concept that I’d like to propose as a best practice this month has to do with the medical director helping with onboarding an attending physician.
What follows are some best practices that you could employ to help a new physician get familiar with your LivingCenter, so that he/she can hit the ground running. Even a five minute “Hi, how are you? I’m the medical director” type conversation can go a long way.
Meet the new doc – I’ve found that meeting the doctors helps everything work more smoothly in the future. Once a face is attached to a name, future communications are so much smoother.
Introductions – Time permitting, an introduction to the ED, DNS and daytime nursing supervisor is helpful. The ED should be more than happy to give a new doctor a tour of the Living Center.
Things to discuss if there’s time – given available time, certain topics will be particularly helpful to discuss:
Familiarity with SNF Rounds – When introducing oneself, it’s a good time to find out about the new physician’s role in their practice and his or her familiarity with SNF rounding and GLC systems. If the doctor is new to SNF rounds, this could be crucial, as their expectations of care monitoring, labs and orders may be very different from the hospital setting. New docs may also have a lot to learn about regulatory requirements for frequency of visits, controlled substance prescribing, and how our medical records system works.
Coverage patterns and preferred contact information – While their office, fax, and emergency numbers should be known to the nursing staff and pharmacy, I have found that docs are willing to share personal cell phone numbers with their medical director for use in emergency. If Dr. James had had the opportunity to discuss coverage patterns, she would have been able to explain that while the medical director is required from a regulatory standpoint to provide emergency coverage, that routine coverage by the medical director as opposed to continuity coverage within is neither preferred nor ideal for patient care. If coverage over vacation is to be arranged, advance notice is ideal.
For non-emergent, non-HIPAA restricted communication, more and more doctors prefer email. If the attending physician would like, we will put him or her on the First Monday distribution list if you provide us with it. Of course one should keep in mind that one should not use the address to spam the physician’s Inbox.
Availability for questions, assistance and feedback – The medical director-attending physician relationship is a two-way street, and making availability clear paves the way for future communications where you may be able to hear about concerns from your medical staff. Also, your doctors may be willing to make suggestions as to process improvements which could be extremely helpful.
Building the relationship – I always tried to briefly interact with my other attending physicians when they were in the LC or hospital at the same time during rounds. Usually we’re both in the middle of something, but just a minute to re-establish contact and remind them of availability can be very helpful.
If you find the time to meet with your new doctor, you may be able to save a lot of time in the future, as well as engage a partner in assuring ideal care in your LivingCenter.
Until next month,
Michael J. Yao, MD, CMD