On this week’s episode, Dr. Alex McDonald and Dr. Shannon Udovic-Constant continue their conversation about caring for their colleagues.

Dr. McDonald: How do you approach this with colleagues who are having issues with caring for colleagues’ family members? What kind of tools or education do you provide; where can people learn about this topic?

Dr. Udovic-Constant: It’s similar to what we’ve already talked about. Make sure you’re checking in with yourself in these situations where you’re taking care of VIPs, these very important people in your life, and check in to make sure that you’re not deviating from standard of care.

I think there’s a difference between helping somebody—a colleague who’s on call, and their nanny contacts them and says their kid is having croup symptoms and seems to be in distress. Come into clinic. It’s lunchtime, but I’ll see you. Versus, “We think it’s croup. I don’t know. Will you send a prescription for steroids?”

For me, there’s a difference between helping them get the care they need and doing telemedicine about something that you wouldn’t have with your other patients. That’s the main lesson. And then the other lesson is setting some parameters around what you’re going to allow.

In my career, I had a colleague who kept ordering medications for a child, and it was not appropriate. I had to have a difficult conversation with her and say, “I’m not comfortable with this. I would hope that you would have trust in me and that I’d be available to you. I’m watching what you’re doing, and I don’t think it’s right in terms of what your child needs. Is there something I can do differently to help you in this situation? Would you like me to facilitate a relationship with one of my colleagues?” And leave it open.

It’s important to have those difficult conversations if you’re getting pushed to do things, send referrals, or order lab tests that you think are not needed. Part of having that difficult conversation is asking, “What are you worried about? Why?” We do this always with our patients, but I think, for whatever reason, it’s harder to have difficult conversations with colleagues. So, again, treat them like you would your other patients and be clear that you’re not stepping out of that standard of care that you would be using with others.

Dr. McDonald: Yeah, that makes perfect sense. One thing that I get all the time, practicing sports medicine, is my colleagues will ask me, “Hey, can you order an MRI for my shoulder/knee/ankle?” I would never do that without examining the patient first, so I always say they need to come in to see me. That’s one of those pieces.

I recall somewhere—I don’t know where—that when people get VIP care, they’re deviating from standards of care and actually end up having lower quality and higher utilization within the healthcare setting. I tried to find some scientific articles on that and I couldn’t find anything. But my gut reaction is that makes sense with what I’ve experienced and seen.

Any residents listening out there that want to do a research project, send me an email. I think that’s something that we could certainly look into: the quality of outcomes for patients who dictate the care, whether they’re a physician or not, and how that impacts things.

Dr. Udovic-Constant: You reminded me of this. I think it doesn’t come up as much in pediatrics, but that “curbside consult” where you don’t get to do an exam. If I were teaching on this topic, the other piece that I would be clear about is make sure that you’re properly documenting, keeping good records, and getting good exams when you need it, so that you don’t find yourself missing something important.

Another incredibly important piece in this space is confidentiality and being super clear that you’re not going to share information. Over the years, I have had some intense conversations with people about difficult life things. Also, as the young people I treat get older and become teenagers, I reinforce the confidentiality piece.

They often know that I know their parent. So, with the parent in the room, I’ll say, “There are laws in California that prohibit me from disclosing some information. Even though I know your parent and we go to meetings together, it’s against the law. I’d get in trouble if I talked with them about some things that you might share with me privately, in confidence.” And then I tell the parent, “You can trust that law also protects me to be able to share things if your child’s at risk.”

That’s the other piece that I think is important in this space, because I don’t want young people to not have comfort in talking to me about sensitive things.

Dr. McDonald: That is such a good point, especially for our teenage patients, pointing that out in the room with the parent physician with them. I think that’s really helpful. Thank you for sharing that.

Well, this has been a wonderful conversation. I appreciate your time. We could probably go on and on, but we try to keep these short and high-yield. My last question, which I ask everyone: what makes you most proud to be a physician?

Dr. Udovic-Constant: Just one thing? [Laughing] I love that every day I get to show up to work and make a difference in people’s lives. Sometimes it’s sharing a joke. Sometimes it’s remembering an experience. Sometimes it’s making an important diagnosis. And sometimes it’s shedding some tears together. It’s making a difference and sharing in this humanity that is our lives.

Dr. McDonald: Yeah, so well said. I really appreciate your time. Thanks for sharing your insights and your wisdom. I look forward to hearing from you and all of our listeners out there soon.

Dr. Udovic-Constant: Thank you.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.