Capsule endoscopy is used to examine parts of the gastrointestinal tract that cannot be seen with other types of endoscopy. The process uses a very small camera attached to a long flexible tube to view the intestinal tract. The technology is particularly useful when disease is suspected in the small intestine and can sometimes diagnose sources of bleeding or causes of abdominal pain such as Crohn's disease or peptic ulcers.

A group of gastroenterologists at the City Medical Center proposed the purchase of capsule endoscopy equipment through the Capital Equipment Purchasing process. After the equipment was approved and the purchase initiated, providers began the process of applying for specific privileges to use it. Three gastroenterologists, Drs. Smith, Sams, and Amalfi, applied for credentials and were approved by the department of gastroenterology and, ultimately, the Medical Center Board of Directors to use capsule endoscopy.

After the three gastroenterologists began to use the new equipment, they discovered that a surgeon, Dr. Jones, intended to use the capsule endoscopy equipment for procedures, too. Having done this procedure at another competing hospital on numerous occasions, Dr. Jones had also been privileged through the department of surgery and, ultimately, the City Medical Center Board of Directors. When Dr. Jones put his first case on the schedule for the gastroenterology suite where the capsule endoscopy was to be performed, Nurse Tattler called the gastroenterology department and alerted them to this potential intrusion.

Drs. Sams, Smith, and Amalfi were outraged. They had advocated for the equipment, and this poacher was attempting to enter their domain. While each of them told Dr. Jones that they liked him "as a person," they were not willing to share their new toy with him or the surgery department. They felt strongly that they "owned" the equipment and the suite. He would just have to go elsewhere.

Dr. Jones pointed out to the trio that the hospital purchased the equipment with capital equipment dollars; the Department of Gastroenterology did not pay for it. In addition, the suite and the nurses who staffed the suite were employees of City Medical Center, not of the Department of Gastroenterology. And, he had been privileged by his department and the City Medical Board of Directors.

Tempers flared, and the chairs of the two departments were informed of this escalating conflict. Since Dr. Jones had scheduled the procedure and the patient was expecting to have it the next morning, the chairs called an emergency meeting with all the involved parties.

Questions

1. What questions do you think the chairs of each department should ask?
2. Dr. Jones has a busy practice and is the second-highest revenue producer from general surgery. City Medical Center is dependent on revenue from the surgical service. How might this impact how the situation should be handled? What specific steps should be taken to avoid this situation in the future?
3. The goal of physician privileging is to ensure that providers practicing in an organization have appropriate credentials to provide safe and effective treatment. What are three challenges illustrated by this case?
4. Who are the stakeholders in the privileging process at City Medical Center?
5. Who is responsible for communicating about specific privileges?
6. Would these physician behaviors be considered "patient-centric"?
7. Are these physicians "team players"? Explain your response.
8. Reread this case. Using Figure 18-3, the Confidential Teammate Evaluation Form at the start of this chapter, compare the behavior of these physicians with the expected behaviors of teammates. Score each physician as if he or she were your teammate. What scores did they earn?

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