Well, my computer is massively infected with a virus or worm or something and I will likely have to call the Geek Squad or something. In the meanwhile I am typing on this 10 year old slow-as-molasses laptop while I get the main computer back in shape.
Here is a quick one about a type of doctor we all have to deal with when we work in the ER. He or she is known as “The Consulter”. Why? Because this doctor simply cannot function without calling a consultant in to see their patient. Whether they need to be admitted or whether they can be discharged, this doctor MUST have a consultant involved. Patient has pneumonia? Call Pulmonary. Patient has chest pain? Call Cardiology. Pt has a sprained finger? Call Orthopaedics. Pt is upset? Call psych.
In my opinion, this type of doctor is costing the health care industry tons of money. The smart internist or family practitioner (or in one particular case that we have at our hospital), or endocrinologist (who has mostly primary care patients and I swear the only thing I think he is comfortable doing on is his own is to adjust insulin!) who manages the more straightforward cases without consults needs to be praised. If you consult cardiology for every cheap chest pain rule out myocardial infarction, you are going to incur tons of specialist billing. For the low risk person who can get an outpatient workup, the last thing you want to do is call a cardiologist in the hospital - they are going to order expensive things like Thalium Scans – which are probably not useful in a low-risk subset of patients.
Not to mention, it is a serious annoyance to have to call 5 consult doctors at midnight for this lazy stupid guy who can’t handle an elderly nursing home patient with a UTI and fever! He usually is not comfortable with us just writing some orders for him. I can tell you how enthusiastic they are to hear from me then! I usually preface the history of the patient with “I am sorry to have to call you now but Dr So and So is admitting a patient and he needs some help”. Of course Dr So and So usually wants the consultant to come in a see the patient in the middle of the night – but does he get his butt out of bed? Never! After all, he feels like his is giving them business! Ugh.
Grrr.
Hm, my link didn’t show up.
Let’s see if this works:
http://crasspollination.blogspot.com/search?q=egregious
Reminds me of a lot ( not all) of the ED docs I work with who will not discharge home anyone over about 70 years old with ANY complaint, or any age adult ( even an 18 yo with a completely atypical story and no OBJECTIVE data to support anything other than a chest wall strain) with the complaint of chest pain without a medicine consult, including the patient with an OBVIOUS zoster rash. Some of them take one look at the patient and decide they need to be admitted no matter what and embark on running up to a gazillion dollars worth of tests until they find an abnormality of sufficient magnitude to justify the admission ( Why did you perform an EKG on a patient whose chief complaint is eye pain? I kid you not.) I suspect the admitting MD’s who are compulsive consulters are either really lazy, really dumb, or more than likely really defensive. I suspect the same thought process ( or lack thereof) occurs with some of the ED MD’s as well. Welcome to the world of defensive medicine. You’ve got to share the risk with someone.
Well, in my group, I would say about 50% of us are pretty good a getting elderly people out of the ER if they have a non-serious complaint. I like to think I am one of them…
However, there are sometimes when one just does not have the time to do what is necessary to safely discharge the patient – and often social work is involved. In our hospital this pretty much means an admission – we have no way of dealing with the droves of elderly mildly demented people who live by themselves and have no nearby family. They fall down – they get admitted. It is sad but the truth.
The main point of my post though was that some of these bumbling internists need to utilise our hospitalists to minimize unnecessary consults. They are more up on inpatient medicine (obviously!) and are more comfortable in dealing with patients who have complaints outside a narrow spectrum. Many of these guys just are too old school and won’t give up the control….