Contemporary medical practices place patients, healthcare providers and families in circumstances with complex moral questions and difficult decisions. Such situations have given rise to ethics consulting where help is given. Health care givers, parents, families or other parties are involved in this process in order to tackle uncertainty or conflict concerning value-laden issues that merge in health care. This brief essay has given an example of a consultation situation and provides reasons why it is different from other clinical roles.
In order to establish a consultation, it is important to compare the concept of consultation with other related concepts such as co-management, referral, collaboration, or supervision. The principal characteristic that differentiates consultation from co-management, referral, and supervision is the extent to which one assumes liability for the direct clinical management of a problem that falls within one’s expertise (Caplan, 1970). Hameric et al, (2009) offer a description of supervision, consultation, co-management and referral. They argue that supervision is overseeing the work of a less senior professional aimed at developing skills of the supervisee, with the responsibility for clinical outcomes (Hameric et al, 2009).
They also define consultation as an interaction between two professionals whereby the consultant is deemed to have specialized expertise where as co-management is deemed as the process where one manages an aspect of care. On the other hand, referral is defined as relinquishing of responsibility, either for short-term or permanently, while another professional manages other aspects of the same patient’s care (Hameric et al, 2009).
The consultation with the physician followed all the steps as found in Hameric et al, (2009) except for the documentation step. The fact that there was no documentation for the consultation renders it informal. The main objective of my consultation with the physician was to evaluate the physician`s needs and attend to the problem effectively. Emphasis was on the physician’s difficulty in handling the situation; hence, I did not take an objective approach in the scenario. As a consultant, I was able to aid the physician identify the factors interfering with the ability to see the patient realistically. The physician had initiated the consultation. The informal nature of the consultation mentioned above was nonhierarchical and collaborative.
Despite the informational nature of the consultation, my consultation with the physician conformed to the basic characteristics of a clinical consultation. These include consideration of contextual factors when responding to the request for consultation. In addition, the consultant has no direct authority for managing patient care. The consultant does not prescribe, but makes recommendations. The physician is free to allow, or refuse the consultant’s recommendations. The consultant evaluates the request, performs an assessment, determines skills required to address the problem, intervenes and evaluates the outcome (Benner, Tanner & Chelsea, 2009).
Essentially, this was an informal consultation, since it was not documented for any further use or action. The physician wanted to get a consultant’s perspective of the problem presented by her patient’s failure to trust her. This lack of trust had resulted to the patient trying to make an internet search on every decision that the physician made. As the consultant, I acknowledged her frustration and allowed to cool down. I proposed a plan that was accepted by the patient and nursing staff. The patient was allowed to try a vaginal delivery, but due to the large size of the baby, this was not possible. Eventually, the patient ended up having a cesarean operation. However, this was not until all options for a vaginal delivery were explored. The patient was able to admit that she was given a full opportunity to deliver vaginally, but the size of her baby, and not the physician’s decision necessitated the Caesarian operation.