Recently, when I needed some expert help at home to install the hardware for my family’s high speed internet access, I learned quickly that this work is done by several types of professionals — electricians, phone technicians, as well as independent contractors who specialize in internet and home computer solutions. Clearly there is a lot of “turf overlap,” and that struck a familiar chord; in medicine we are increasingly discovering people coming to the same quality solution from different places.

For example, patients with back problems might make an appointment for a neurosurgery consultation with Jon Park, Steve Ryu or me. Or they might contact orthopedic surgery for an appointment with Gene Carragee, Todd Alamin or Ivan Cheng. Orthopedists and neurosurgeons provide excellent service and thus share weekly Emergency Department call for spine trauma.

Of course a fair amount of “brand loyalty” exists. For example, put a plastic surgeon and a head and neck surgery (aka otorhinolaryngology) specialist together over cups of coffee here or anywhere in the nation, and each will offer a compelling rationale why rhinoplasty belongs in his or her service. At SHC, both teams offer this procedure — and they also trade weeks on call for facial and jaw fractures.

Need cosmetic surgery? Are you thinking plastic surgery? Not necessarily. Dermatologists have become active in cosmetic surgery, too.

As a member of the Credentials Committee, I see increasing requests to expand services’ menu of privileges — often for procedures traditionally performed by other specialties. For example, vascular surgery recently added endovascular treatment of aneurysms of the aorta to its palette — a procedure previously in the exclusive domain of interventional radiology. Carotid stent placement for treatment of stenosis is a relatively new procedure, but it’s already on the privileging form of at least three different services.

And while some specialties are adding “minimally invasive” scenarios to their privileging forms, other services are going in the opposite direction by adding more “radical or invasive” procedures.

This new look at privileges is occurring under the careful eye of the Credentials Committee and the Care Improvement Committee (Quality Assurance). All physicians performing similar procedures — and their services — are held to the same quality standards: the committees monitor procedures and outcomes for uniformity throughout SHC.

So why expand privileges to a new service when a procedure is already being provided excellently? There are several drivers, including the need to increase capacity. But a compelling reason flows from the heart and soul of our mission as an academic medical center priding itself on providing first rate, cutting edge residency training programs.

All of our services understand that they must offer comprehensive programs to recruit top candidates. Understandably, we might have difficulty attracting top housestaff candidates during the match if applicants were told that experience in an important new procedure was available to them at every potential match —except Stanford. A young physician would find little consolation in discovering that another housestaff member in another specialty at Stanford will be learning that skill instead.

It’s important that all of our trainees gain the skills needed to make their skills comprehensive and applicable nationally. This, in turn, will help make Stanford Medical Center the nation’s best institution not only for scientific discovery, but for patient care and physician training as well.

To achieve this goal of comprehensive excellence, we must work collaboratively. Therefore, we might be seeking your help. When a service seeks to add a privilege, members of another service already providing that service may be asked to review the request. We need to make sure that these reviews are conducted in a fair but rigorous manner. The bottom line will be excellent outcomes throughout the institution. Keep in mind that the public will be aware of our comprehensive, interdisciplinary quality via “report cards,” based on our outcome measures, which increasingly are being disseminated to the public. So by pitching in when asked to evaluate a procedure, we can make sure all of our services, not just our own, are delivering the type of care we would expect for ourselves and our families.

As we go forward, I am sure that there will be changes in who does what. We will probably see more instances of “overlapping expertise” or “turf overlap.” Let’s work together rather than against each other to provide the best outcome for our patients. After all, at the end of the day I now have to stop and think whether the person who set up the hardware for my home network so expertly was the telephone installer or the electrician. But I still have her contact information and will not hesitate to pass it on.

Happy New Year!

lshuer@stanford.edu