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Paging Plastics

The Issues Confronting the Most Consulted Service

Patel, Anup M.D., M.B.A.; Shah, Ajul M.D.; Clune, James E. M.D.; Chang, Christopher C. M.D.

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Plastic and Reconstructive Surgery: April 2012 - Volume 129 - Issue 4 - p 774e-775e
doi: 10.1097/PRS.0b013e318245eac7
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Sir:

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Plastic surgery routinely involves problem solving and innovation, as the specialty is confronted with a gamut of clinical problems.1 The number of restorative options available that can address complex problems has led plastic surgery to become one of the most highly called-on services. Plastic surgery residents are often the first line of representatives addressing these consultations, ensuring optimal management of patients, growth of the service, and innovation in the field. This communication attempts to provide solutions to potential problems that can arise as one of the most consulted services.

Given the well-established association of plastic surgery with reconstruction, many consultations relate to the evaluation of wounds. Many wound assessments lead to nonoperative management. Training programs must remain cognizant of the challenges for future residents who will need to evaluate an even higher volume of nonemergent consultation requests while meeting the demands of any major academic service. Dealing with consultations requires a balance of preventing work-hours restrictions and avoiding depletion of resources versus loss of valuable learning opportunities when primary care residents opt to call a more available service for what may be considered “bread-and-butter” plastic surgery consultations.2

Collaborative didactics between surgical specialties and nonsurgical fields may be a solution. A discussion can be introduced, accompanied by a series of didactics highlighting principles of wound healing and when a plastic surgeon's skill set is necessary for the management of wounds. Developing an intranet portal restricted to consultants only and that harnesses the power of telemedicine to transmit digital images of soft-tissue deficits can be of benefit in expediting the evaluation of nonoperative consultations and enhancing use of plastic surgery resources.3,4

Physician-patient communication has been cited as the key to patient satisfaction.5 The difficulties of maintaining communication are more intricate in the context of such a highly consulted service within the hospital. Morning rounds necessitate efficiency, especially when considering that nearly every patient will mandate wound care. Residents need to spend adequate time to provide patient care while meeting the service's demands and concomitantly complying with duty hours. Unfortunately, as these services expand, it is possible that some patients will feel unsatisfied with the physician-patient encounter.

The recognition of difficulties that may face the discipline in the future is nothing if not an opportunity for early growth and development. We would propose the following solutions to improve the relationship and satisfaction:

  1. A pamphlet would be created and handed to the patient (also on the Web) that would include the following:
    1. Team member pictures, including names and roles.
    2. List of dressings that may be applied to the patient during rounds.
  2. A statement regarding the timing of rounds and that a specified member of the team can return for further discussion.

The future of plastic surgery is filled with endless opportunities for growth. However, with this growth will come challenges at meeting the everyday demands of delivering appropriate care. We hope that these proposals will invoke discussion for providing this optimal care to our patients.

Anup Patel, M.D., M.B.A.

Ajul Shah, M.D.

James E. Clune, M.D.

Christopher C. Chang, M.D.

Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn.

REFERENCES

1. Rohrich RJ, Rosen J, Longaker MT. So you want to be an innovator? Plast Reconstr Surg. 2010;126:1107–1109.
2. Song DH. Professional perceptions of plastic and reconstructive surgery: What primary care physicians think (Discussion). Plast Reconstr Surg. 2010;126:651–652.
3. Otake LR, Thomson JG, Persing JA, Merrell RC. Telemedicine: Low-bandwidth applications for intermittent health services in remote areas. JAMA 1998;280:1305–1306.
4. Pap SA, Lach E, Upton J. Telemedicine in plastic surgery: E-consult the attending surgeon. Plast Reconstr Surg. 2002;110:452–456.
5. Virshup BB, Oppenberg AA, Coleman MM. Strategic risk management: Reducing malpractice claims through more effective patient-doctor communication. Am J Med Qual. 1999;14:153–159.

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©2012American Society of Plastic Surgeons