The case presented (Ethics Forum, May 2014) is a fairly common event in our (academic) institution. A rule of thumb we always use is to ask the referring physician for clear milestones and measurement criteria for success or failure and to provide to the referring physician our guidelines for withdrawal of therapy.
Explore this issueJuly 2014
For instance, in this case the ophthalmologist must state in advance what he or she expects at six weeks, 12 weeks, etc., with consensus that failure to achieve those goals will result in withdrawal (or, much less likely, intensification) of therapy, and the rheumatologist might cite diabetes, hypertension, psychosis or bone loss rules.
We articulate the rules on both sides before proceeding.
Michael D. Lockshin, MD, MACR
Director, Barbara Volcker Center for Women and Rheumatic Disease
Hospital for Special Surgery
Professor of Medicine and Obstetrics-Gynecology
Joan and Sanford Weill College of Medicine of Cornell University
New York, New York
Author Kirk D. Jenkins, MD, Replies
We appreciate Dr. Lockshin’s interest in our article and his insightful comments. Outlining “rules of engagement” can help set expectations at the start from all parties involved. A plan for the ophthalmologist to communicate treatment goals and for the rheumatologist to provide guidelines for medication management is an excellent way to start the dialogue. Good communication between providers, regardless of the strategy, is critical for success when dealing with complex patients who require multidisciplinary care.
Kirk D. Jenkins, MD
First Year Rheumatology Fellow,
University of Kentucky
Member of the ACR’s Committee on Ethics and Conflict of Interest, Lexington, Kentucky