 What? What's wrong? I think we just saw a drive-through consult. Yes, or what we sometimes refer to as a curbside consult. To put it bluntly, a curbside approach is not appropriate for a consultation on an active patient case. Actually, you did several things well. Your early decision to not rush your formulation of the ethics question, there were moments where you did just fine. But, others not so much. My primary concern was with the way you gathered information. Or didn't. You took what Dr. Ingersoll said at face value, and it was pretty clear that she was hoping for a specific answer. I know you wanted to help her, but you only heard one side of the story. Actually, this whole episode illustrates the point that I was trying to make before we were interrupted. If you have consistency of procedures, your life gets much easier, and you're less likely to make mistakes. Plus, new team members are easier to train. And it's easier on you too, because you don't have to make it up as you go along and wonder whether you made the right choices. I guess that's what we've been doing. Well, one day you're going to retire, or win the Lotto, or whatever. I mean, do you want the new people coming in to be told, we don't really do things here the same way every day? You're just going to have to feel it? I think we get the point. So what do you recommend? What should we do to make sure that our response is consistent? I am so glad you asked. You have too much free time. I know you've seen this acronym in the Primer. C-A-S-E-S. Each letter stands for a step in the consultation process. The first letter C stands for clarify, as in clarify the consultation request. Make sure you know what the requester is asking for. And make sure that it's really appropriate for an ethics consultation. Hang on. What do you mean by appropriate? You have to make sure that the requester wants help resolving an ethics concern. Somebody may have a legal question or an allegation of misconduct or just a general complaint. But these aren't what we mean by ethics concerns. What we're looking for is uncertainty or conflict about values. Among requests that are appropriate for the ethics consultation service, you have to determine whether it's appropriate for case consultation. Remember, an ethics case consultation is an ethics consultation on an active patient case. You might get asked a question about a hypothetical case or a case that occurred in the past, or you might get asked a question about a policy. Now these might all be good questions for your team to handle, but the cases approach is designed especially for case consults. When you're asked to help with an active patient case, think C-A-S-E-S. Cases, cases. Scott, that is a lovely sign, but could you go put it somewhere else? Sure. Yeah. I think this would be a good time for us to take a look at those consult records we asked you to bring. What's the matter? Show them the box. Ooh. Now before you say anything, we know we need a better filing system. Four box matches either way. What? Procedural consistency should also apply to documentation. The documents your processes generate and the way those documents are managed. But that's for later. For now, let's just sort through and find something we can use to help demonstrate the cases approach. Uh, let me see what I can... Oh. Okay. Oh. Oh, here's one. Mr. Cull, hang on. Is it okay for us to use names? Yeah, that's a very heads-up ethics question. Absolutely. And yes, we will be discussing identifiable health information. We are here in an official training and quality improvement capacity, and we're in compliance with all the rules. We have a business associate agreement and all that, but try to stick to the minimum information we all need to have. Okay. This is Mr. C. Uh, he was your case, remember? A permanent resident? Oh, yeah. I remember. He kept saying that since he was a veteran, he was entitled to stay as long as he wanted. Did he even do windows? Oh, boy. Remember the family where the wife was refusing a blood transfusion for religious reasons? Jehovah's Witness, I think it was. Oh, I remember this one. They wanted me to tell a critically ill patient about the death of his sister. We found out about it while we were prepping him for surgery. This one was a lab technician complaining that a coworker was falsifying the time card? Need it. Need it. Got it. Got it. Need it. Got it. Ooh, I'm not messing anything up, am I? Uh, patients from other things that food is unhealthy. Patient's sister wants a television to turn down. Chinese restaurant wants you to pay your tab. Look, I said we know it needs cleaning up. It's not a question of organization, although I will admit that that's an issue. Their floor coffee machine needs to be fixed. Nurse Ratchett needs to weekend off her facelift. I'm surprised no one turned their car in for detailing. They get it. You're saying that these are requests that should not have been handled by our team? Hey, she really does get it. Of course, not every case you mentioned was wrong for the team, but it sounds like some of them should have ended with the initial phone call. Others could have been reframed to focus on the ethics question. Which is the first step that we're asking you to standardize so that everybody who calls the team will have the same experience. When it comes to the first call, I mean. Clarify the consultation request. C for clarify. We should have referred some of these requests elsewhere. Yes, some of them are in purview of other departments, compliance or social work or even chaplaincy. But we don't want to send people away, do we? We want people to know we're here and to use our services. Look, I know you want to help, and that's why you're in this line of work. But the bottom line is the Ethics Consultation Service doesn't have time to do everything. And you are making a positive contribution by directing them to the people who are in a better position to help them. Precisely. Now that we've discussed the elements of a consultation request that make it appropriate for case consultation, we'd like to do another exercise. On the worksheet labeled Exercise 2, you'll find synopses of several requests. Discuss which of these requests would be appropriate for the Ethics Consultation function. Make sure you consider the reasons why the request might or might not be appropriate. As before, we'll take 10 minutes for this, and when the on-screen counter hits zero, we'll return to the video. You folks are making our job pretty easy. How about we grab some lunch and then we'll keep moving through the cases approach? We've still got a lot to cover because clarifying the consultation request is only the beginning. But no wisecracks about the hospital food. What did I say? What did I say? Oh boy, she put you in your place. This concludes Part 1 of Ethics Consultation. In Part 2, the integrated ethics coaches will continue familiarizing the hospital's team with the cases approach and will watch the team take on their first consultation with their new found skills. See you soon.