Question

Case 32: Heck No, I Won’t Go! I’m Not Covering for Free!

On Thursday night Dr. Jones was at home watching television and spending time with his family. The phone rang. The South Shore General Hospital ER physician asked him to see an urgent patient. Dr. Jones replied that he was not on call for the emergency room at South Shore General Hospital, and furthermore, the hospital was paying members of a competing group to cover the emergency room. The emergency room doctor said that he was aware of the arrangement with the competing group. However, the ER could not reach the on-call physician and had tried for some time.

Dr. Jones, who earlier had a glass of wine with dinner, responded, “You’ll have to keep trying. I’m not coming in.”

The next day Dr. Jones called the Chief of Staff and the Chief Medical Officer (CMO) of South Shore General Hospital and informed them that neither he nor any members of his group would cover the ER unless they were compensated in a similar manner to the competing group and had an appropriate contractor arrangement with the hospital. Dr. Jones asked the Chief of Staff and CMO if they worked for free. Dead silence. “While you’re thinking about that question, let me say this to both of you. Doctors are working harder and longer hours and earning less money every year. Why should we give up our free time and work for nothing when you’re willing to pay the other group?”

CASE WRITE UP (PLEASE INCLUDE DETAILED EXPLANATION AND COMPLETE )

* PLEASE BE ADVISED THAT MY ROLE FOR THIS CASE IS CHEIF MEDICAL OFFICER

- Alternatives and Recommended Solution

- Evaluation

THEIR IS AN EXAMPLE BELOW OF HOW THIS SHOULD LOOK!!!! --- I NEED Alternatives and Recommended Solution & Evaluation part done

Case Write-Up

Background Statement

A Wiccan patient who visited a nondenominational community hospital was discussing her religious beliefs with her primary care nurse, Penny Baker, when suddenly another nurse, Ruth Goose, walked into the conversation and rudely stated, “Thou shalt not suffer a witch amongst you.” The Wiccan nurse felt offended and complained that she was discriminated in the hospital because of her religious beliefs.

Major Problems and Secondary Issues

The major problem is that the two nurses, Penny Baker and Ruth Goose, made the patient feel unwelcomed in the nondenominational community hospital because of her Wiccan religious beliefs. The secondary issues that the nondenominational community hospital may face is that the Wiccan patient is threatening to go to the media. This means that there may be news coverage that your hospital engages in religious discrimination. This may make people, especially Wiccans, look down on your medical services.

Your Role

In this case, I am the Vice President of Nursing Services. As stated in the text, it writes, “You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient, who is a Wiccan.” The advantages of this role are that I can sit down with Penny and Ruth to let them know that religious discrimination is not to be tolerated while we are caring for the patients. The disadvantages of this role are that I must decide how I am going to discuss this matter with Penny and Ruth because they’re passionate about being against the Wiccan patient. I need to let Penny and Ruth know that our patient’s care matters above everything else, not what religion they practice.

Organizational Strengths and Weaknesses

As the Vice President of Nursing Services, my strengths are that I can hold a training on racial, ethnic, and religious diversity. This training can supplement nurses with the information they need to work in a diverse environment. Nurses need to know that they must treat their patients justly despite their identity. The weaknesses I may face are that the two nurses are very religious themselves. They may not listen to what I have to say about religious discrimination because the two nurses try to justify their act by saying, “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?”

Alternatives and Recommended Solution

As a solution for this problem, I will make sure to provide all the nurses working in the hospital with diversity training. It is important that I sit down with the nurses and make it clear that discrimination will not be tolerated while they are working in our hospital. I can also offer every patient visiting the hospital with a survey. The patient can fill out the survey to let us know how they felt about their stay. Nurses who’ve been accused of any sort of discrimination, will have to speak with management. We would keep these incidences of discrimination in a file, and it the dilemma does not change, I would have to begin writing up the nurses. Discrimination would not be tolerated while the patient is in the hospital trying to recover from a medical condition. I would also recommend Penny and Ruth write an official letter of apology to the Wiccan patient before she decides to go to the media. Writing the official letter of apology would be my first recommended solution to Penny and Ruth, so that the patient does not feel unwelcomed to our hospital’s services in the future.

Evaluation

If there are enough surveys to prove that our medical treatment is getting better and there are less patients coming from the patients about discrimination, then I would know that the instances of discrimination have stopped. The goal is to aid in the medical recovery of patients. Patients must also feel welcomed to our hospital services despite their identity. By getting fewer, or even better, no discrimination complaints, I would know that my diversity trainings and meetings have worked.

Answer 1

Background statement:

A situation of personal encounter with of the Chief staff and chief medical officer of the south shore general hospital with   Dr Jones who comes up with emphatic rhetoric that why the doctors should work for free? This is related to the yesterday night’s situation when a regular non-emergency physician,Dr Jones was called by emergency room physician for an emergency patient when the regular doctor who was covering the emergency on call was not answering to the phone call.

Dr Jones did not attend the emergency call and asked for repeated calling to the unresponsive emergency physician belonging to the competing group covering emergency. He is now in the  room of the Chief staff and chief medical officer   asking  if they work for free, visibly upset about being asked to come for emergency the last night.. He has emphatically put a query that why should the doctors give up their free time and work when they are already working harder and longer hours when the hospital is willing to pay the other competing group more compensation and not paying the regular physicians adequate compensation to cover in the emergency.

The main problems and secondary issues.:

The main problems are unavailability and unresponsiveness from the doctor of the the competing group covering the emergency, unwillingness of the regular physician to cover emergency outside the working hours ( as he thinks that would be working for free) and the compensatory discrimination between the regular physicians and the doctor covering the emergency.

.The non availability of the emergency doctor and quality patient care is the main problem that I have to urgently address by restrategizing the staffing and scheduling of the emergency room physician coverage.

The other parallel issue that I face is the regular physician disssatisfaction about discriminatory compensatory packages for emergency coverage to the competing group and the regular physicians as the hospital is paying seperately to the competing group covering emergency and the regular physicians attending emergency outside the regular working hours are not separately compensated for the same.

Your role:

I am the Chief of staff and the Chief Medical officer of the South shore General Hospital. I am responsible for the physician staffing at the hospital in Outpatient department,inpatient department and emergency setting. I have to ensure that the patients in the outpatient setting in patient setting and the emergency room are covered adequately by the the medical doctors. I am overall responsible for the the physician organisation /scheduling /allocation /distribution and delivery of the quality patient care in the the hospital and bridging the same with hospital administration.

Organisational strengths and weaknesses:

As the Chief of staff and the chief medical officer of the South shore Hospital, I am in position of command and responsibility and can make an alternative staffing arrangements for the emergency Room In view of the above situation by making alternative contractual arrangements/ new hour based emergency compensation package for the regular physicians attending emergency after their duty hours

I am in position to seek explanation from the the unavailable emergency doctors on call. The weakness In my role here would be the inability to take the financial decisions on account of the hospital and my dependency on the chief financial officer, budgeting officials and the administrative head for the alternative contractual arrangements and the changes in the compensation package for the regular physicians covering emergency calls outside the duty hours

I can also hold a meeting with the chief financial officer to draw out a parallel plan of compensation for the emergency care rendered by the routine physicians of the hospital on hourly basis enabling them to attend a the emergency calls with adequate compensation in my strength of being a chief medical officer.

Alternative and recommended solutions:

As concrete solutions of the problem,

1.I will face Dr Jones with a counter rheotoric that the doctors have an ethical responsibility to attend emergency when no other physician is available . I will also point out that his behaviour at the urge of emergency has been inappropriate and issues related to compensation can be discussed following the procedural norms of the hospital in the regular working hours. I will remind and caution him that refusing to attend the patient emergency is against doctors ethics and moral responsibility.

2. I will understand from Dr Jones once he has calmed down about the willingness to come for emergency if offered additional compensation, the expectations as to the the compensation desired with regards to attending the emergency is in the hospitalI and take an objective account of the perceived Compensatory discrimination felt by him.

3.I will solve the problem of non availability of the doctor for the emergency room by Rescheduling and restaffing the doctors immediately by changing the schedule  of  the competing group from one doctor per emergency shift to two oncall doctors per shift one primary and other standby doctor( in cases of unresponsiveness)

4.I will be holding a discussion with the Chief financial officer and try to find out the discrepancy and differences in the pay structure of the physicians covering the emergency room and the regular hospital physicians; understanding the provisions emergency coverage compensation in their existing pay packages.

4b I would chart out hourly basis compensation for the regular non emergency physician based on the pay structure to the emergency physician from the competing group in order to to resolve the monetary discrimination for the regular non emergencyphysicians attending the emergency calls outside their work hours. I will make contractual arrangement to that effect if required..

5. I would also remind Dr Jones about the ethical and moral responsibility which doctor has to attend an emergency call in the absence of the other doctors. I will hold an ethical meeting of all the hospital regular physicians and the emergency room physicians reminding them of the ethical and moral responsibility they have in the case of patient emergency and patient care and ask for availability and prompt responsiveness to the phone calls from the hospital in the emergency in specific.

6.I would enquire with the regular physicians as to how many of them are willingng to attend the emergency is outside their working hours and their expected compensation for the same performing a questionnaire survey at the meeting.I would also warn the doctors both from the regular hospital physician’s group and the competing group about the strict disciplinary action that would be taken in the failure to to attend emergencies as assigned

7.Alternatively,I will get in touch with the contractor of the competing group of emergency physicians covering the hospital and the doctor who had not responded to understand the reasons for the lack of response and take administrative action for the same.

8.Based on the inputs from the financial officer, administrative department and questionnaires from the regular physician serving the hospital.I would work on the restaffing and Rescheduling and new compenasatory packages of the physicians on call for emergency.

Evaluation

1.:I will evaluate whether the physicians from the competing group are responding/attending to the calls from the emergency promptly as per the new staffing and rescheduling by checking with the emergency room physicians on the regular basis.

2. I will maintain a register of the number of calls from the emergency that had to be taken by the regular physicians on account of non availability of competing group physicians and decide if the need of continuing with the separate contractual facility for the emergency.

3. I will evaluate the new compensatory packages for the regular physicians who are attending emergency beyond their regular hours to ensure a whether a fair compensation had has been made to them as compared to the competing group physicians

4.I will monitor regular availability and the lack of physician response episodes by seeking feedback from the emergency room physicians for both thecompeting group/ regular physicians and note the no emergency show incidences with utmost seriousness.

5. I will evaluate whether the medical staff in the the hospital demonstrates adequate ethical and moral behaviour in dealing with the patient care especially the emergency care

6 I would also evaluate the satisfaction among the regular physicians for the emergency roles assigned to them and the related compensation packages

The final goal in evaluation will be to observe that no emergency patient is left to wait for the physician or doctor to attend and ensure quality patient care by careful replanning the emergency room services and physician schedule.