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Re: Co-management From: Lynn Montgomery (apgar10@thebirthcentermt.com) Wed Apr 23 15:53:44 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Lynn Montgomery: "Re: Male partner association with anembryonic gestation" Previous message: Glen Elrod: "Re: Co-management" In reply to: Glen Elrod: "Co-management" Next in thread: Robert J. Carpenter, Jr. MD, JD: "Re: Co-management" Reply: Robert J. Carpenter, Jr. MD, JD: "Re: Co-management" Glen, I can respond to this in that I have dealt with FP's doing obstetrics in a "co-management" situation my entire career. In reality, there is no "co-management", in that you are still the more highly trained specialist and as others have eluded to, you WILL be the deep pocket if something untoward happens. I have approached these situations on an individual basis and as I learned from Bob Carpenter, I document the hell out of my opinion, recommendations and my interpretation of my role in the patient's care. I keep close tabs on the patient and if there is a departure from my recommendations, as guided by the FP, discuss things immediately with him/her and if the departure is unacceptable to me, I write another note excusing myself from the care (not inflammatory, but factual). The FP, as the primary, certainly has a choice whether or not to accept my opinion as a consultant, but as the consultant, I also have the ability to "sign-off" the patient's care if it is unacceptable to me. I do not think you will find any "legal definition", in that the definition is what you and the FP arrive at during the time of the initial consultation. In the example you provided, given that you were not notified, as the obstetric consultant, of the patient's hospital admissions, I would excuse myself from the care. I fully realize that this can be politically charged in that we rely on primary care referrals in our practices, but I have found that "good" FP's recognize when they may be out of bounds and will stay with you and defer to you when appropriate. The ones who don't are likely best left to their own rewards. Lynn -- Lynn D. Montgomery, M.D. Obstetrics & Gynecology, Maternal-Fetal Medicine The Birth Center/Rocky Mountain Women's Health 1211 S. Reserve St. Missoula, Montana, 59801 406-549-0978 fax 406-549-0987 e-mail: apgar10@thebirthcentermt.com ________________________________ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Glen ________________________________ Elrod Sent: Wednesday, April 23, 2008 1:40 PM To: Multiple recipients of list OB-GYN-L Subject: Co-management Does anyone have a legal definition of co-management with regards to patient care? I have been asked by a local FP to co-manage twins with her. She has done a one year postresidency fellowship in obstetrics and does c-sections etc. One two occasions now the patient has been admitted for preterm labor (once by an FP partner without such fellowship training) and on neither occasion were my partner or I consulted with regards to her care. On questioning this, I was told that co-mangement meant being available for the delivery to assist as needed. Thoughts? Glen ________________________________ Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try ________________________________ it now. <http://us.rd.yahoo.com/evtQ733/*http:/mobile.yahoo.com/;_ylt=Ahu06i62 sR8HDtDypao8Wcj9tAcJ > Next message: Lynn Montgomery: "Re: Male partner association with anembryonic gestation" Previous message: Glen Elrod: "Re: Co-management" In reply to: Glen Elrod: "Co-management" Next in thread: Robert J. Carpenter, Jr. MD, JD: "Re: Co-management" Reply: Robert J. Carpenter, Jr. MD, JD: "Re: Co-management"

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