Case Study: The New Toy at City Medical Center
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.
Discussion 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. Who is responsible for communicating about specific privileges?
4. Would these physician behaviors be considered “patient-centric”?
5. Are these physicians “team players”? Explain your response.
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