Walk the Line As a 3rd year pulmonary and critical care fellow, I am just a few mere months away from real life; from making decisions solely on my own and relying on my training and common sense when tough situations arise. I have had wonderful training and, for the most part, I feel fairly confident that I will be able to work my way through just about any situation that arises. If not, I know my mentors are just a phone call away and I am truly grateful for that reassurance. Recently, however, I have encountered a couple situations where my choices have been thoroughly challenged. As a subspecialist, we are there to provide consultation. We are there to offer our assistance, but not to be the primary decision maker. The primary care team bundles all the subspecialty information together and directs the plan of care. Recently, I had a patient whom home safety had come into question. The primary physician was not available, and I just happened to be in the “wrong place at the right time,” depending on how you look at it. I spent 3 hours of my evening trying to sort through social issues and suffered a lot of heartache and grief during the process. A few days later, I encountered a pulmonary consult for hypoxemia in a patient who had recently decided to go into hospice. I honestly did not understand why we were being consulted since the patient and family had decided to take that road. When I met with the patient and family, it was obvious that the situation and plan of care had not been explained adequately. The patient and family had many questions that had gone unanswered. No one had taken the time to listen to their needs. The patient longed for comfort only and wanted end of life care; one filled with dignity and pain control. An hour later, after a long discussion and a few tears, I signed the comfort only order set. The family thanked me multiple times for my empathy and for actually listening to their concerns, something they said no one had been willing to take the time to do. During these situations, I was simply trying to do the right thing. But my fellow peers have informed me that I am handling things that are not my responsibility. These issues are ones that the primary care physician should be handling, not the pulmonary and critical care physician. So how do you draw that line? How do you separate what is and isn’t your responsibility as a physician? Because quite frankly, I feel like treating the patient as a whole, is my responsibility. If other physicians involved are not providing services that the patient desires, than is it not my responsibility at that point? While I do agree that I should not have to deal with some of these issues, I feel a duty and the need to handle these types of situations when no one else is providing these services for my patient. I cannot turn my back and hope that someone else will fill in the gap. Patient care comes first, no matter what subspecialty you may have chosen. As a patient advocate, I feel this is my job, even if I am only a consultant. I suppose learning how to better deal with these situations will come with more experience. And realizing how to meet that fine line but not cross it will be more evident to me in the future. I have no idea how long the learning process may take, especially since I tend to be extra tender-hearted and sometimes take the weight of the world upon my shoulders. But until that time, I will continue to walk the line and cross it when better patient care demands it – not only because I took an oath or because I feel an obligation, but because my heart tells me this is the right thing to do.
Posted on: Sun, 22 Sep 2013 23:53:18 +0000
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