"We engage in a 'team based' model of intervention here"
I'm sorry. 'Teams' are not licensed. Individual providers are licensed and have to operate responsibly and according to professional standards of care/practice and not engage in MAL-practice in order to maintain their individual license.
I predicted this crap several years ago when the damn VA waved a bureaucratic wand with all the policies / procedures / software around 'Mental Health Suite' and 'integrated, interdisciplinary team-based treatment planning' as well as the entirely manufactured role of 'Mental Health Coordinator' position.
The traditional roles/rules that ensured competent clinical practice are now finally being blurred/erased and now 'the team' 'writes' 'the plan' rather than an individually licensed provider/specialist seeing a patient (evaluating, say in context of a consult) and engaging in informed consent process with the patient, doing treatment planning, writing the treatment plan, and then implementing their treatment plan. 'We have team plans.' No, we have a 'team' of individually licensed providers who have different skills, knowledge, experiences, competencies, etc. I cannot write a treatment plan for the nurse practitioner saying that she will prescribe Zoloft for patient X when she has never even seen patient X before. I can enter a consult to her for med management and we can go from there.
A 'team' approach doesn't mean that my slick/Machiavellian colleague can pull a fast one and throw into the permanent medical record a 'treatment plan' that is a 'team' plan that, curiously, only lists one name (my name) as:
(1) the sole 'team member' (nobody else is listed); Let that sink in. I haven't even seen the patient in my life but, somehow, I am now the SOLE 'team member' involved in their care. Where's the 'team,' jack?;
(2) there is only one objective ('my' objective that was written for me outside of my knowledge, consent, input by someone else) to implement a very specific time-limited treatment protocol the evaluation of suitability for which there are multiple qualifying and disqualifying factors that I am supposed to evaluate in answering the consultation request for that service; but my colleague has dispensed with the entire consultation process and just skipped to writing my results/plan for me; (3) I am listed as the responsible person for implementing X protocol over Y number of weeks with patient Z (there are no other objectives or interventions in the plan)
It is clear to me that this provider is so motivated to immediately eject this patient from their caseload in order to beat the clock prior to the intern leaving the rotation that he is insisting that I sign a 'treatment plan' that is CLEARLY indicating that it is MY treatment plan (see above) when I haven't had the opportunity to actually examine the patient and respond to the consult that he entered for me to evaluate the patient for suitability for X protocol (the answer to which may be a 'yes' or it may be a 'no'). He wants me to commit to the plan prior to doing the evaluation and answering the consult. To me, this is indisputably inappropriate but in the current political environment when we have a team meeting next week I am anticipating that the program manager is going to bring this topic up (I hope they don't) and I am going to be having to fight the ideology of me not being 'a team player.'
He is going to say that he is just trying to comply with the 'rule' (policy/procedure) that is ridiculous that we must have a treatment plan published by session 3. Fine. The patient is still under YOUR care in YOUR caseload so feel free to finalize/write for YOURSELF whatever treatment plan you want at session 3. I see two possible ways of handling it:
(1) [this is what I do] If I have seen the patient for an intake (he's in my caseload at that point), send him to orientation group, then have session 3 treatment planning session with him but he 'chooses/picks' protocol X that Dr. Z offers, fine. I first write a treatment plan with one objective and me as the responsible person (he is, in fact, still my patient at that point). My treatment plan is generic and basically says, 'cognitive behavioral therapy for PTSD' and it has a 12 month duration at this point (6 months, whatever). I enter the consult for Dr. Z to evaluate for suitability of protocol X and IF Dr. Z evaluates and decides that protocol X is appropriate then Dr. Z can enter his own objective covering that intervention and be responsible for it.
(2) I can put in a 'placeholder' objective basically saying that I'm entering a consult for Dr. Z to evaluate for protocol X and make it like a 2 month objective (to be safe) in order to give time for the consultation to be completed.
What frustrates me is that no one has foreseen this and it seems like no one is interested in maintaining integrity of actual practice of clinical care (including having clear points of transfer of patients between providers (and rules/principles governing these), maintaining continuity of care so people don't fall through the cracks, and following standard of care with respect to the steps of evaluate --> plan --> treat.
I guarantee you that the discussion is going to be about 'being a team player,' the 'needs/preferences' of the veteran (for a particular protocol), 'veteran-centered care' and 'we're a team here.' I'm sorry, but 'we're a team here' doesn't give my colleague carte blanche to just write my plans for me and insist that I sign them as my plans.
And the intern is being taught that this is appropriate clinical practice. I told the intern point blank that if he goes to his first real job and starts writing and publishing into the permanent medical record treatment plans on behalf of his colleagues making them the 'sole responsible person' for the sole clinical objective for a patient without even consulting with them first (on a patient they have NEVER SEEN OR EVALUATED) and expects them to just sign it then he is in for a world of professional pain and it may even result in a board complaint.