Coordination between services

The structural organization of the contemporary hospital can constitute an obstacle in its own right to effective communication with patients and their parents about the plan of care in complex medical cases. Intensive care units providing technically sophisticated support are typically staffed with specialists in critical care, but the patients whose illnesses have reached a critical point can be referred to those services from a variety of different specialties – transplant, cardiology, pulmonary medicine, oncology. When the attending physician on the referring service and the ICU attending have different priorities, opinions, or treatments for the same patient, whose opinion governs care? This is not a question that should be determined by power within the institution or hierarchy of medical specialties, but realistically, there are few areas of human interaction in which relative power does not play a role. Coordination, communication, and cooperation between services is a problem of organizational structure, too important to be left prey to the personalities and varying skills of individuals.

The problem of coordination and communication arises on many levels. In many hospitals, the physicians in training, the residents, have more contact with individual patients than their supervisors, the physicians who are training them in their specialty, but quite rationally might fear to challenge their decisions. The various professional groups among clinicians, united by a Hippocratic commitment to the well-being of their patients, nonetheless may have differing priorities, reflecting their different professional ethics.