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…

Conflict Resolution & Consultative Medicine

Chad Vokoun, MD

UNMC – Internal Medicine

Associate Program Director

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

Conflict Resolution:The Role of the Chief Resident

Chief Resident

Patient Advocate Resident Advocate

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”

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

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”

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.

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.

Ten Commandments of Effective Consultation

Arch Intern Med 1983

Ten Commandments of Effective Consultation - I

• Determine the question

Ten Commandments of Effective Consultation -II

• Determine the urgency

Ten Commandments of Effective Consultation - III

• Look for yourself

Ten Commandments of Effective Consultation - IV

• Be brief

Ten Commandments of Effective Consultation - V

• Be specific

Ten Commandments of Effective Consultation - VI

• Provide contingency plans

Ten Commandments of Effective Consultation - VII

• Honor Thy Turf

Ten Commandments of Effective Consultation - VIII

• Teach with tact

Ten Commandments of Effective Consultation - IX

• Talk is cheap but effective

Ten Commandments of Effective Consultation - X

• Follow up

Curbside Consultation

• OK for general questions

• OK for education

• Caution with specifics

• Medical-legal implications

• Document