Understand patient care from physician perspective
The right tactic can help eliminate animosity
When Carol Reeder, RN, BSN, MSA, first goes into a hospital to consult on setting up a physician-aligned case management model, she encourages case managers to try to understand what physicians have to deal with in their daily practice.
For physicians, only about 10% to 15% of their focus is on hospitalized patients because they have other demands on their day, she points out.
"Physicians often have crises going on with patients calling them from home, patients in the office. Case managers don’t always appreciate the complexity of the physician side," adds Reeder, a consultant with McCaw Park, IL-based Cardinal Health Consulting & Services.
On the other hand, when case managers are in a hospital setting, their entire focus is the patients in the hospitals. "The case manager/physician relationship fosters trust, respect, and helps provide continuity of care for the patients," she adds.
She cautions case managers to emphasize that they are working to ensure that the patients get the highest quality of care possible and are not just concerned with cutting costs. "You don’t want them to see your interventions as though the organization is monitoring the doctor from a cost-saving standpoint. That’s the fastest way to turn off a physician."
If the emphasis is on keeping down the length of stay, physicians tend to bristle when they hear the message, Reeder adds. They often say that the case manager isn’t listening to them or taking into account that the patient is an individual with specific needs, she adds.
She advocates that the case managers talk to the physicians in the physician group they work with to find out their likes and dislikes. For example, find out when they want a case manager to call them and whether they’d prefer that the case manager call their office, cell phone, or page them. "The case managers should let physicians know that they are not trying to be obtrusive but want to help them. Ask the physician what they want to know and when they want to know it, and make sure they have the information," she adds.
Reeder encourages case managers to make rounds with the physicians so they’ll be on hand to ask questions. For instance, if a case manager looks at a new admission for appropriateness and there is a question, the case manager never should suggest to the physician that the patient’s admission is inappropriate.
"The approach we encourage is telling the doctor that there isn’t enough information to get the admission certified and is there something else he or she is thinking about. In casual conversation, the case manager can get enough information to get the patient approved," she adds.
Case managers should tread lightly to make sure the physician doesn’t construe their suggestions as telling them how to practice medicine, Reeder cautions. For instance, instead of reminding a physician his or her patient with pneumonia needs a chest X-ray, the case manager could say, "Did you want to schedule the chest X-ray today?"
When Carol Reeder, RN, BSN, MSA, first goes into a hospital to consult on setting up a physician-aligned case management model, she encourages case managers to try to understand what physicians have to deal with in their daily practice.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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