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Tue Jan 5 19:14:52 GMT 2010

That sounds like patient care by a committee to me. Who is in charge of patient care? The cardiologies checks out the heart, the orthopedist is the technician who does the carpentry part of the surgery, the anesthetist puts the patient to sleep, the clinician talks to the family, the physician therapist walks the patient . Who gets the informed consent? Who tells the patient about the complications that occurred in the OR? 

Sorry to be cynical but who is the patient's physician?

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Felix Albers
Sent: Tuesday, January 05, 2010 1:05 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: kids FRAUD

we also have at our hospital a special ward dedicated to eldery patients 
with hip trauma. criteria for admission are: age > 65, trochanteric, 
subtrochanteric or femoral neck fracture. there is a cardiologist and a 
clinician who do all the pre-op workup and post op care, a physiotherapist, 
social assistant, etc. the idea is to operate this elderly people as a 
priority, normally we do it in 1 or 2 days, avoiding prolonged bed rest and 
so on. in this phase of care it´s the clinician who communicates with the 
family and patient. we do all the post operative ambulatory care.

Felix

----- Original Message ----- 
From: "Mohammed al Malik" <traumawon at hotmail.com>
To: <trauma-list at trauma.org>
Sent: Tuesday, January 05, 2010 4:42 PM
Subject: RE: kids FRAUD

>
> Dr. Gross
>
>
>
> It appears to me that those in teaching hospitals and in county hospitals, 
> such as here at LA County Hospital, do not fully comprehend the kind of 
> practice which is mandated by the hospital and the HMOs and insurance 
> companies such as my hospital and obviously as happens in Brazil.    We 
> are forced to allow the clinical case managers to actually order much of 
> our treatments by protocol, and we are hands off.   It is to our advantage 
> to be a collaborative team, with an admission going to that product line 
> service.    Look at how we treat cancer patients with the treatment 
> determined by the tumor board, and not by a specific surgeon.   This way 
> the best practice is given with comparisons to national benchmarks.    Dr. 
> Gross, in all due respect, I believe that this is the way that programs 
> like Kaiser and Mayo health systems work.   It seems that this is the way 
> that our California Governor and President Obama want us to practice 
> medicine and the laws will be written to cause us
>  to get paid from the single payer systems and public options and the 
> public payment for the private options if we abide by their regulations. 
> We have already been doing this kind of practice without talking about it 
> for years.     Yes, the pediatricians assume all of the order writing and 
> the communicating with the patients and the parents, while the surgeons 
> can do what they do best, operate in the operating room.
>
>
>
> Mohamed
>
>> From: felixalbers at terra.com.br
>> To: trauma-list at trauma.org
>> Subject: Re: kids FRAUD
>> Date: Tue, 5 Jan 2010 16:16:06 -0200
>>
>> I work in a big traumatology service in southern Brazil, where this legal
>> issue is not (yet) a big problem like in the US.
>>
>> Since august 2008 our service changed and now patients are admitted not
>> anymore on the name of one doctor, but in the name of the service. Even 
>> in
>> the electronic registry there is "Responsible Physician: Trauma Service".
>> Residents see admitted patients daily and there are daily rounds with the
>> staff of the given day. Decisions are made in a group, and post-operative
>> care is not done by only one doctor.
>>
>> Advantages: cases are more "visible" to everybody, residents learn even 
>> more
>> because they see more cases and decision making every day, everybody 
>> knows
>> about all patients, and multiple opinions about management lead to better
>> decisions.
>>
>> Disadvantages: some patients have complained about not knowing "their
>> doctor", what I understand completely. also, some cases that become
>> complicated lack a leader taking the difficult decisions. protocols are
>> needed more than ever for the routine cases.
>>
>> About lawsuits (the few times we had them since august 2008) with this 
>> new
>> system, patients sue the hospital, not the physician.
>>
>>
>> Cheers
>>
>> Felix
>>
>>
>>
>> ----- Original Message ----- 
>> From: <nappio at aol.com>
>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>> Sent: Tuesday, January 05, 2010 3:56 PM
>> Subject: Re: kids FRAUD
>>
>>
>> > That's not an advantage.. They'll sue all your butts off.dn
>> > ------Original Message------
>> > From: Mohammed al Malik
>> > Sender: trauma-list-bounces at trauma.org
>> > To: trauma-list at trauma.org
>> > ReplyTo: Trauma-List [TRAUMA.ORG]
>> > Subject: RE: kids FRAUD
>> > Sent: Jan 5, 2010 12:44
>> >
>> >
>> > We practice as a team, just as your trauma service surgeons cover each
>> > other for take back operations and rather than just one doctor being in
>> > charge, a lot of doctors assume the broad risk. This way if there is a
>> > law suit, it is difficult to determine just who is responsible. That is
>> > one advantage of collaborative practice.
>> >
>> >
>> >
>> > Mohamed
>> >
>> >> From: Krin135 at aol.com
>> >> Date: Tue, 5 Jan 2010 12:20:14 -0500
>> >> Subject: Re: kids FRAUD
>> >> To: trauma-list at trauma.org
>> >>
>> >> no, Sir. in a true collaborative practice, there would still be *one*
>> >> primary physician, and each consultant would take the time to read and
>> >> evaluate
>> >> what the primary has done and planned, and what each of the other
>> >> consultants had done and planned, so as to *reduce* duplication and
>> >> eliminate
>> >> conflict.
>> >>
>> >> the primary physician (team leader in a teaching hospital, or 'admit 
>> >> to'
>> >> physician in a non teaching hospital) has the responsibility to ride 
>> >> herd
>> >> on
>> >> the consultants and make sure that they are being used properly.
>> >>
>> >> This is something that many folks who trained as 'true specialists' 
>> >> have
>> >> forgotten...
>> >>
>> >> ck
>> >>
>> >>
>> >> In a message dated 1/5/2010 11:12:40 Central Standard Time,
>> >> traumawon at hotmail.com writes:
>> >>
>> >> I must say that all of our patients are consultant rich and sometimes 
>> >> the
>> >> orders and treatments are duplicative and conflicting. But that is the
>> >> way
>> >> it works in a collaborative practice.
>> >>
>> >>
>> >>
>> >> --
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