Monday, November 9, 2015
Too many cooks in the kitchen syndrome
There's a new epidemic sweeping American hospitals, and a cure is desperately needed. It's highly contagious and causes the sufferer much anxiety and psychological suffering. It also costs the health care system millions, if not billions, of dollars a year. You may never have heard of it. You won't find it in the medical textbooks nor will you hear any of the great teachers of medicine talking about it. It has a strange name: Too Many Cooks in the Kitchen Syndrome. Okay, it's not actually a medical illness and doesn't have its roots in the biology of the human body. But it can still be very disabling and disruptive to the individual, and importantly affects hundreds of thousands of hospitalized patients each year. Ask any frontline doctor and they will see it in action each day on the medical floors.
The scenario goes something like this. A patient is admitted to hospital and due to the complexity of their illness, they will end up seeing a number of different specialists. In the old days, their primary care doctor would still be seeing them in the hospital. Now however, they are typically assigned to an internal medicine doctor, known as a “hospitalist”. The problem is that this hospitalist usually hasn't met them before, so has to start from scratch. Depending on the case, other specialists involved in their care may also include surgeons, cardiologists, pulmonologists, nephrologists, gastroenterologists—you name it! But due to the busy environment of a hospital, there will often be very little direct communication between these different doctors. For instance, it's a highly common occurrence for one specialist to tell the patient one thing (e.g. “Your heart is definitely the problem”) and another specialist an hour later to say something completely different (“Your lungs are definitely the main problem”!). In between, the hospitalist wouldn't necessarily be getting regular updates on what's being done, what new medications are being given, and how the treatment strategy may have changed. All this while the patient is being overwhelmed with information from so many different physicians!
The above situation plays out all across the country every day, and is actually emblematic of a much bigger problem—namely, the fragmentation of the health care system. It negatively effects patient satisfaction and the hospital experience, causing a lot of frustration and miscommunication along the way. So what's the solution? Well, the start would be to make it absolutely crystal clear who the “captain of the ship” is during the hospitalization. This will usually be the hospital physician (for a medical patient). The next step is to ensure that every specialist who sees the patient understands who this primary doctor is (and also re-emphasizes that to the patient), and communicates their plan immediately to them. This doesn't have to be a lengthy process, and could be as simple as a “text page”. The next thing is to get the hospital physicians on board themselves to take on the mantle of “captain of the ship”—even if care is mainly being directed by another specialist e.g. a patient awaiting a surgical procedure. Furthermore, these physicians need to have adequate time to take on this role, so it's critical that they shouldn't be overwhelmed themselves with excessive workloads.
Patients need to know who their main doctor is in the hospital—the main port of call—in order to feel comfortable and always have a go-to person. While many physicians may be involved in getting them better, there can only ever be 1 clear chief. That's the way to avoid Too Many Cooks in the Kitchen Syndrome.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Suneel Dhand, MD, ACP Member
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