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Monday, November 23, 2009

Thanksgiving dishes: parable for consultants.(LETTERS TO THE EDITOR). USA, LLC

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To the Editor: My brother Harry and I rose from our postprandial slumber to do Thanksgiving dishes. I was the washer. He was the dryer. There were a lot of dishes. I handed him one with a smudge of gravy. Noticing it, I said, "Give it back," to which my brother replied, "a good dryer never gives a dirty dish back." He wiped it clean.

Consultants, it seems to me, can and should act as "good dryers." I am not talking about covering up for malpractice but instead about dealing with the minor deficiencies in thought, action, or interpretation or the modest delays that occur in everyday practice. How many times have we heard from patients or read consultants' reports that reflect unfavorably on referring physicians? After all, we refer patients for the consultants' expertise. And consultants have several advantages. They did not struggle with diagnostic or therapeutic questions as early as the referring physician did. Time has passed by the time they receive a referral. Laboratory results and images are generally available. Most importantly, consultants can make a more knowledgeable diagnosis and/or decision to initiate treatment.

Most physicians I know care deeply that they do no harm; the Latin primum non nocere is not just a saying for malpractice lawyers. Being human, we do make errors, both those of commission and omission. However, when delay in the patient referral is minimal, when therapeutic or diagnostic error does not rise to a level of malpractice, or even when the judgment is made that we should have known something that we did not, what harm is there in the consultant recognizing the Golden Rule (Do unto others as you would have them do unto you), or, as I would say, being a "good dryer." After all, to the primary care physician will the patient return--maybe.

I do believe that collegial relationships are becoming more strained in our productivity-based world. As we become busier, we have less time or inclination to be involved in a community medical society. Medicine has become more complex with its rich array of tests and increasingly narrow areas of specialization. As primary care physicians, we cannot expect to be totally prepared for all that we see, but we must learn to recognize what we know and what we do not. And when we do not know, we either find out or, if appropriate, refer the patient to a consulting physician. Referrals can be good both for the patient and the primary care physician. The consultants most revered by colleagues are those who take good care of the patients we have entrusted to them and who educate us. The "gotcha" consultants are not held in such high esteem. Hubris from a consultant is never appreciated.

Bendaputi et al (1) reported on a patient survey regarding the ideal attributes of physicians they encountered at Mayo Clinic. Among these were empathy, humanity, and respectfulness. Osler taught equanimity in our role with patients. In Aequanimitas (2) he speaks of "the need of an infinite patience and of an ever-tender charity toward these fellow creatures." That is a good lesson for consultants as well and a key to maintaining collegial relationships. Consultants play a critical role in our practice. I believe they should remember the lesson of the good dryer and Thanksgiving dishes.

Charles T. Thornsvard, MD

Billings Clinic

Billings, MT

1. Bendapudi NM, Berry LL, Frey KA, Turner Parish J, Rayburn WL. Patients' perspectives on ideal physician behaviors. Mayo Clin Proc. 2006; 81:338-344.

2. Osler W. Aequanimitas: With Other Addresses to Medical Students, Nurses, and Practitioners of Medicine. Philadephia, PA: P Blakistons Son & Co; 1920:7.

Source Citation
Thornsvard, Charles T. "Thanksgiving dishes: parable for consultants." Mayo Clinic Proceedings 82.11 (2007): 1434. Academic OneFile. Web. 26 Nov. 2009. .

Gale Document Number:A171541603

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