Running Head: WHEN PROFESSIONAL OPINIONS COLLIDE 1

When Professional Opinions Collide:

An Inter-Professional Communication Situation Analysis

Snohomish Brown

Pacific College of Oriental Medicine

WHEN PROFESSIONAL OPINIONS COLLIDE 2

When Professional Opinions Collide: An Inter-Professional Communication Situation Analysis

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.

As an illustrative example, in my experience as a Physician of Chinese Medicine in Los

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

looking for attention I just can’t take the torture anymore!”

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

to Inter-Professional communication and collaboration have been identified by researchers in the

position of evaluating healthcare providers in team environments (O’Daniel & Rosenstein,

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.

According to barriers identified by O’Daniel & Rosenstein, we can identify several of

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

(Interprofessional Education Collaborative, p. 16, 2016). Finally, the historical inter-professional

WHEN PROFESSIONAL OPINIONS COLLIDE 6

rivalries between Osteopaths, MDs, and Acupuncturists can account for the remaining drastic

steps which undoubtedly led to this Osteopaths termination as my patient's Psychiatrist. If he

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

initiative in fostering an enabling environment, including offering access to needed resources,

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
WHEN PROFESSIONAL OPINIONS COLLIDE 7

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

mentioned in this example, other barriers to successful discussions about

integrative therapies include provider indifference (or opposition) and patient

fears of a negative response from the other providers. Bauer-Wu and others

conclude that inhibited conversations in this manner are not respectful of

patient autonomy and are inconsistent with patient-centered care (Bauer-Wu,

Ruggie, & Russell, 2009). I would like to use more standard measures when

evaluating the risk of mental health disorders, or at least be able to see

results from other providers who administer these assessments. Until better

inter-professional communication is made a higher priority than “Cover your

Liability” Medicine, this will take significant effort to achieve in my opinion.

WHEN PROFESSIONAL OPINIONS COLLIDE 8

References

Academic Collaborative for Integrative Health (2011). Competencies for Optimal Practice

in Integrated Environments. Mercer Island, WA: Author.

Bauer-Wu, S., Ruggie, M., & Russell, M. (2009). Communicating With the Public About

Integrative Medicine. Washington D.C.: Institute of Medicine.Gold, C. (2017). BU805

PowerPoint Slides Fall 2017 Week 1 [PDF file]. Retrieved from:

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

Interprofessional Education Collaborative. (2016). Core Competencies for Interprofessional

Collaborative Practice: 2016 update. Washington, DC: Interprofessional Education

Collaborative.

O’Daniel, M. & Rosenstein, A. (2008). Chapter 33 Professional Communication and Team

Collaboration. In: R. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based

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.

Los Angeles, CA: Author.