Dr. Collins sighed as she picked up the phone. She was dreading the upcoming exchange because she could predict how it was going to go and it wasn't going to be pretty. The Emergency Room was crazy tonight. There were more patients than bays and patients were being held in the halls. The waiting room was overflowing. The drunk with the hand laceration had cursed at her as she tried to sew him up. She had been having trouble getting patients transferred from the ER to the medical wards and specialty units. Although she felt that she had the ultimate authority about who should be admitted and where, she had been receiving resistance from Dr. Waxman, the Intensivist on call tonight. Tempers were getting short and the nurses was pressuring her to get the "DKA in bed one" up to ICU NOW. As she dialed the phone for the Intensive Care unit, she braced herself for the argument she knew would follow. She asked to speak to Dr. Waxman,

The ICU was also having a bad night.  Of the six beds, five were filled-- three with patients on ventilators and the remaining patient had sepsis. In addition, the Emergency Room had called for an evaluation of a patient two hours ago. Dr Waxman had gone to the ER to assess the patient, only to determine the referral was completely inappropriate for the Unit.  He was angry that that the unnecessary evaluation had caused two hours of his time- time that he just did not have tonight.  He became angry when his authority to determine who can be admitted to ICU was questioned. Not only did his interaction irritate him- to complicate matters, the head of the ICU had recently admonished him on the importance of using the hospital established physiologic criteria when deciding which patients to admit at the ICU. Apparently, earlier in the month, an insurance company denied coverage for a patient they determined were admitted inappropriately to the ICU. He wondered, how is it fair that he could be held responsible for who was admitted to the ICU, if he did not have the authority to make the final decision. When he tried to speak to Dr. Collins about the inappropriate request- she blew him off, mumbling something about if he had complaints, he should get in line. In addition, Dr Waxman knew the ICU staff, who were feeling overwhelmed, were depending on him to protect them from additional work. When he heard Dr. Collins was on the phone, he was sighed and reluctantly picked up the phone. He knew how this was going to go and it wasn't going to be pretty.

 

How do you evaluate this situation in light of the information, the viewpoints put forth by Morton Deutsch (Cooperation and Competition).