She has been in hospital for 2 weeks.

Because she is complex, a plan is required to manage her. And it is important that there be a multi-disciplinary team that is collaborating and keeping the family updated.

Unfortunately, there was no plan. That became very evident during and after the case conference.

The case conference involved 12 persons including a bio-ethicist, the MRP ( most responsible physician), the hospital’s 2 psychiatrists, GI medicine, the dieticians, the nursing team, the parents) and Raymond Rupert from RCM Health Consultancy as well as RCM’s nurse practitioner and RCM’s in house psychiatrist.

The MRP led the discussion. Each doctor provided commentary. The actions taken to date were reactive. The hierarchy was at work. Most others at the case conference were not allowed to comment.

It became very clear that the hospital did not have a plan. They disregarded assessments done elsewhere. The not invented here syndrome.

This case conference bordered on chaos. I was embarassed by it.

The attendees are going to be surprised when we ask for another case conference next week to see what the treatment plan is.

Persistence and collaboration will be important to get the best outcome possible for this patient.

Raymond Rupert patient advocate and healthcare consultant.

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