Best way to handle rude specialists?

[Guest ERCat]

I've had a few issues with transferring patients to a local hospital for dermatology, ophthalmology, and other specialities we don't have on call. Frequently these specialists are SO RUDE. I recently had a patient with a battery acid to the eye and wanted him sent over to this hospital. When I called the physician resource line I was told the doc refused to talk to a PA. I had the clerk explain that I WAS the provider taking care of this patient and the only one who had evaluated him or knew anything. He still said he refused to talk to me and told me to find a doctor who would evaluate him and then have that doctor call him!!! So my attending physician had to step out of a room and get this - basically I stood there and he asked me the questions of the ophthalmologist, then told the opthalmogist to hold while he got the answer from me, then repeated my answer! We both thought it was so disrespectful and rude. What do you guys do in situations like this?

[sk732]

I had someting similar happen with an orthopedic surgeion known throughout the area as an arsehole...when he wouldn't talk to me, I kept the line open and handed the phone to my doc and said as much that "this clown only talks to real doctors..."   When I was in primary care, I had an issue with this same guy, so basically I don't send him business anymore - if it's something that can wait, like a cast clinic referral, I'll set it up with the oncoming call doc - so I hit them in their wallets and call them as I see them.   It's my irritable ADD/Army SNCO side coming out.

 

I have to say though, I've never had an issue with an ophthalmologist - they usually don't frig around with things.  For billing purposes here, they just want the name of my attending, as they need a billing number attached to the consult in order to bill provincial health care.

 

$0.02

 

SK

[EMEDPA]

hit them in the pocketbook. send consults only to folks who will talk to you. this is one of the reasons I work rural and solo now. all the local specialists here know there is no doc around and they have no problem talking to me. that was one of the big things I hated about working at urban truma ctrs, docs who were assclowns who pulled that crap.

[Boatswain2PA]

If it's nonemergent then "okay, please tell Dr. Dumb$hit that I will be sending this patient to their competitor", document the conversation and tell the patient you ate sending them to Dr. Competitor because you've had problems referring to doctor Dumb$hit.

 

If it is emergent, then "Okay, tell Dr. Dumb$hit that I will be sending this patient to the closest ED with (insert specialty) coverage". Then call the ED and tell the doc there why you are sending pt through ED instead of directly to specialist.

 

If your in ED, then it's "Okay, please tell Dr. Dumb$hit that this is an EMTALA violation and I am documenting it as such, and I will be transferring the patient to another ED where he can receive care." Again, tell receiving ED doc what the back story is.

[jwells78]

Typical.

 

Want to know why that provider does that?

 

A. He/She's been burned by a half-a$$ report from an NP or PA

 

OR

 

B. He/She is just a clown

 

Best way to handle it?

 

Never give a half-a$$ report. Know why youre transferring, what the pt needs that your facility cannot provide, and every single detail they will ask before they ask it.

 

Only way (PAs) will gain audience with (A) will be to force acknowledgement of our attention to detail and skillset.

 

As far as (B)- just smile; friends close, enemies closer....

 

Above all- dont let it get uder your skin. Grow that $$it as thick as you can.

[ventana]

happened in my own practice.

 

Had a patient with Bullous pemphigoid. Old school derm doc wanted a letter from the PCP Doc (had to be the doc, not me) 

 

(he had requested a letter stating it was okay for HIM to treat this patient with a high risk medicine - only signed by a Doc)

 

 

I explained to him that I was a 99% practice owner, the doc has never seen the patient, and I would not be requesting him to sign a doc a letter.

 

As I had already worked with on derm on a different case of BP and had read up on the medicine in question I had already researched everything, and said it would be fine - even mentioning the points of concern.  He held fast, and so did I.

 

this was late fall, and the patient winters in FL - down there I recommended a second derm consult - where low and behold he saw a PA who blew them out of the water with her knowledge and approach.  She started him on a few new meds, and basically got him in remission.  Upon their return north he had zero lesions - and I continued to manage it with her input via telephone...  

 

I will never again send a patient to this dermatologist - ever, and in fact will actively steer patients to other providers.  

 

As for the patient - he loved me, and fired the derm......  We (myself and another PA) did what was right for the patient and they understood completely. 

I 

[roger777]

I think there is probably a lot of low hanging fruit like that where you can do a better job than a Doc. Family med doc in my last rotation was so unbelievably checked-out in his patient care.