Too Many Cooks in the Kitchen

One of the wonderful things about an academic institution like Stanford or UCSF is that you have specialists of all kinds. It's pretty common to get a smattering of consultations for patients with complex problems, whether medical, surgical, psychiatric, or something else. We have cutting edge tests, tools, and therapies. However, having "too many cooks in the kitchen," so to speak, can be frustrating at times. I remember as an intern last year, my consultants would occasionally contradict each other or keep the patient in the hospital for tests that were really outpatient issues. The primary team is always aware of how long a patient has been in the hospital. Consultants, on the other hand, often take advantage of the convenience of a patient being admitted and keep them there longer than necessary. Even right now, on the pain consultation service, we are seeing several patients whose main or only issue is pain management. One patient is having multiple procedures to try to control his pain, but the scheduling of these procedures and technical problems with them have kept him in the hospital longer than necessary. It's good to have access to lots of consultants, but it also creates confusion of who is in charge and drives up the costs of medicine.