NewsLine — September 2009 - (Page 22)

Section 2: Reaching Out Keeping the Attending Physician Involved By Joan K. Harrold, MD, MPH, FAAHPM A n apple a day may keep the doctor away, but as hospice professionals we should be asking, “How do we keep the doctor closer?” And not just any doctor—the patient’s attending physician. Per the Hospice Medicare Conditions of Participation, we know that the attending physician “is identified by the individual, at the time he/she elects to receive hospice care, as having the most significant role in the determination and delivery of the individual’s medical care.” Unfortunately, keeping the attending physician in that “significant role” is often quite challenging. Several factors increase this challenge. Many hospice patients are no longer able to travel to physicians’ offices as they had been, making the relationship more difficult to maintain. The attending physician may rely increasingly on the hospice team to utilize its expertise and protocols to assess and manage symptoms. Even helpful observations and recommendations from the hospice medical director may overshadow the attending physician’s input regarding the “determination and delivery” of a patient’s medical care. Despite these challenges, it is important to be mindful of the role of the attending physician. Patients often want to maintain enduring relationships with their physicians despite decreasing ability to visit the office. Patients and families trust that the attending physician knows them— knows the history of their medical conditions and the treatments most likely to help them. And the attending physician may have insight into the unique history and needs of patients and families that will affect them throughout the course of hospice care. One of the most important factors in working closely with the patient’s choice of attending physician is to be certain that you have established how the physician wants to receive information. Some doctors favor telephone calls. That may mean direct conversation or conversation with a member of the physician’s staff with a return call to the hospice nurse if needed. Others prefer faxed information that can be easily filed in a patient’s chart. While urgent communication may dictate immediate and direct conversation, it would be helpful to know how the physician prefers to collaborate about more routine matters. In one practice, the physician became so annoyed with routine faxes from all sources that he had the office fax machine turned off unless he or his staff needed to send a fax. The hospice did not know this and became frustrated with the lack of returned 22 NewsLine

Table of Contents for the Digital Edition of NewsLine — September 2009

NewsLine - September 2009
Contents
Introduction
Archstone Foundation Grant: Exploring the Role of Spiritual Care in Palliative Care
Working for a Greener Future
Transforming Care at the Bedside
Point of Care Documentation: Perception Versus Reality
A Technophobe Signs On
Utilizing Volunteers More Fully
HIPAA and Technology: Some Considerations
Keeping the Attending Physician Involved

NewsLine — September 2009

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