IPC SituationalAnalysisPaper
IPC SituationalAnalysisPaper
IPC SituationalAnalysisPaper
Snohomish Brown
In health care settings especially, there are often tragic consequences as a result of poor
communication. With iatrogenic causes being among the top five causes of death in the United
States, it behooves providers of healthcare to pay more attention to each other if we are to work
effectively as a team. Accordingly, as we would expect, the available research literature indicates
that effective communication can provide many positive outcomes. These include: “improved
information flow, more effective interventions, improved safety, enhanced employee morale,
increased patient and family satisfaction, and decreased lengths of stay” (O’Daniel & Rosenstein,
2008, p.4). On the other hand, especially when there are many barriers to communication,
patients may experience significant difficulty in getting the best care for their needs.
Angeles, California, there was an incident with one of my patients that involved one of her other
health care providers contacting me about her health status. I received a phone call from her
Osteopath, a Holistic Psychiatrist from Orange County who had been treating her for an
unknown period of time. I was aware that my patient frequently shops around for new doctors,
because she is often dissatisfied with their conclusions about her case and sometimes feels that
their care is inadequate or inappropriate for her needs. I had never heard of this provider, but she
changes doctors so frequently that I admit I have had trouble keeping up and have simply not
pursued this as a priority. On this particular phone call, the Osteopath begins by asking me what
gives me the idea that I can treat mental and emotional disorders given my qualifications? I
explained about my training with Dr. Joseph Yang and his highly regarded work in identifying
Shen Qi disorders with his Traditional Chinese Medicine and Psychiatry background (Yang,
2005). I assured the Osteopath that there is plenty of evidence to support the effectiveness of
WHEN PROFESSIONAL OPINIONS COLLIDE 3
such treatments and concluded my response by sharing my treatment protocols over email, as
well as the herbal formulas I was using with her. He replied to my email stating that our patient
was suicidal on Monday, so beleaguered by the psychosis elements of her situation, saying “I
guess there is nothing left to do but kill myself, there is no living this way. I am sorry, I am not
He went on to say that he offered her an anti-psychotic which she wouldn’t take and
insisted that “psychiatric hospitalization is coming if we all can’t make progress on her
psychosis/shen disturbance. Worst case scenario is she makes a suicide attempt.” I thanked him
for the update and related back to him that her treatments were going well and that slow progress
was being made and no mention of suicide plan or even ideation had been mentioned during her
visits. I asked him to describe his treatment goals and how he planned to measure her progress
toward them, also whether her only options were to take the drugs he offered or face
institutionalization. I shared my feelings that my fear was that her reaction to losing her liberty
may have devastating results to her condition and urged him not to present her with a no-win
scenario. I submitted that I realized the danger she could present, if she demonstrated any
potential to cause harm to herself or others, but so far I had not witnessed that at all from her.
His reply confirmed that she had ended treatment after only fifteen minutes in his office, but that
she had also acted this way before. He reported that she rated herself 32.5/40 on a scale he used
to measure for success and therapeutic improvement. “She downplayed her suicidality Monday
saying it was just because she was off her Chinese herbs” he warned. “There is no current
psychiatrist on the case so in light of last Monday suicidality stemming from her psychosis not
being treated and her refusal to take a psych meds (sic) from me to treat the psychosis or just so
she can get some sleep, I feel she is at risk. How much at risk I can’t assess. I will let her father
WHEN PROFESSIONAL OPINIONS COLLIDE 4
know the situation and have left a voicemail for the ND[Naturopathic Doctor's name omitted], to
update him as well. I am pretty clear she needs more intensive psychiatric treatment than an
inconsistent outpatient program can offer her and will make this clear to all involved.”
In response, I offered to suggest some local outpatient psychiatric care for her since travel
to him for her was out of the county and sometimes difficult. The Osteopath agreed, but
indicated that he felt this would still be inadequate for her needs and would result in the same
problems we were currently facing with her. I disagreed with him as did my patient, but
followed through on making other recommendations to her, none of which she accepted,
however she found a new psychiatrist to work with anyway. Since this incident she never was
confined at a treatment center against her will, as far as I know, and never made any suicide
attempts either. Currently she is making satisfactory progress, experiencing less psychotic
incidents, but also taking an anti-psychotic medication to manage her symptoms. Is suspect that
what went wrong was the way the Osteopath approached solving this patient's problem. He did
not take into account the principles of patient centered care and so the patient fired him.
In this situation, it did not seem to me that the communication between professionals
suffered as much as the communication between patient and professional, especially in the case
of the Osteopath. Several of the components of successful teamwork as well as common barriers
2008). In this case, it is easy to pick out several examples. What went well was the open
communication between myself, the Osteopath, the patient's family members, and the other
health providers in spite of our disagreement over the appropriate decision to make. The shared
responsibility for the team's success was obvious. We all wanted to avoid the worst case scenario
WHEN PROFESSIONAL OPINIONS COLLIDE 5
and of course any harm coming to the patient. The non-punitive environment, where providers
are able to speak their mind without fear of reprimand or punishment, was also available.
Though warnings were given, this may have been appropriate, or maybe not, usually time
deficits make full communication impossible. In fact, there were several of my questions which
were not answered. I never got to see the MRI scans which I hear were taken. Also, the measure
the Osteopath used is not identified in such a way to allow retesting. Then there is the issue of
the patient refusing care, which may have been appropriate, though left to be decided by the
patient. The threat of suicide is important to assess, but when assessed in my office: the patient
denied having any ideation of suicide, nor any plan, nor did she present herself as any danger to
herself or others.
those easily as well (2008). Differences in requirements, regulations, and norms of professional
education for the Osteopath in dealing with suicide threats may have been based upon different
experiences than other practitioners and his assessment may have been right from his point of
view. It made no sense to me to keep her under restrictive surveillance, however, that would
probably have made things worse in my opinion. Fears of diluted professional identity came up
for me, especially when the Osteopath questioned my authority to treat mental emotional
disorders. But even after I demonstrated my competency, the Osteopath made no comment on
that whatsoever, but proceeded to steamroll over my questions with his recommendation. The
recommendation I knew was not what the patient wanted however. In any event, the differences
in language, particularly the use of the term Shen (ie, awareness, consciousness, heart-mind),
may have sounded too much like jargon in this case and prevented effective communication
rivalries between Osteopaths, MDs, and Acupuncturists can account for the remaining drastic
would have trusted me to help him keep her mood swings within safe ranges, perhaps we could
have worked together. His lack of trust extended beyond my capabilities, however, and he
grossly misjudged our patient too, threatening both her liberty and her preferences
simultaneously. In the meantime, her progress continues to improve while under my care.
Even though this exchange ended without major incident, the inter-professional
communication in this example could have been better and I wish that I would have done a few
things differently. In searching for strategies to improve interpersonal communication, again the
components of successful teamwork are of tremendous help (O’Daniel & Rosenstein, 2008).
Also, several of the leadership traits mentioned in the class lecture provided additional
inspiration and motivation to make a difference in the way I handle future situations like that one
(Gold, 2017). Proper judgment is necessary to know whether the patient actually downplayed
her symptoms or whether the Osteopath made a bigger deal out of her offhand remark that he
should have. Decisiveness is important and I agree that he did the right thing to alert the other
practitioners about his exchange with her. But it takes courage and loyalty to the patient's
preferences to honor what's truly best for the patient. In light of this, I could have used more
like research in support of the protocols I am using. I admit that I could have probably described
the care I was giving without mentioning the word Shen, but I enjoy discussing these things and
wanted to share something important to me. Core Competencies call for a more disciplined
approach that avoids such jargon (Academic Collaborative for Integrative Health, 2011). I feel
that not many MDs appreciate what Chinese Medicine has to offer, however, and it may take
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some additional research than I can provide to convince them that it is worth their attention. It
would have been nice to see what measures he used to determine the degree of psychosis or risk
of self harm.. He stated that he had no way assess this risk and so decided to err on the side of
extreme caution, presumably only thinking of his own liability and not the patient's or the
family's for that matter. There was never any clear specification regarding authority or
accountability, but these roles were vaguely leveraged and manipulated in various ways to imply
that the professionals had more power than the patient. In the end however, it is the patient that
loses when professionals cannot see the value that other practitioners can bring to the table.
Ultimately it is the patient who is responsible for the decisions and choices she makes, we must
take care not to overstep our authority as providers too. Besides the problems
fears of a negative response from the other providers. Bauer-Wu and others
Ruggie, & Russell, 2009). I would like to use more standard measures when
results from other providers who administer these assessments. Until better
References
Academic Collaborative for Integrative Health (2011). Competencies for Optimal Practice
Bauer-Wu, S., Ruggie, M., & Russell, M. (2009). Communicating With the Public About
http://elearning.pacificcollege.edu/pluginfile.php/267416/mod_resource/content/1/IPC
Syllabus Fall 2017 (Sunday - Sep 17%2C Oct 1%2C Oct 15%2C Oct 29%29 Gold
CWC.pdf
Collaborative.
Handbook for Nurses (1-16). Rockville, MD: Agency for Healthcare Research and
Quality.
Yang, J. (2005). Shen Disturbance: A Guideline for Psychiatry in Traditional Chinese Medicine.