Incognito Posted February 12, 2017 Share Posted February 12, 2017 I had a patient scheduled to be seen for follow up of a cat bite to her wrist. The pt. was hospitalized overnight due to the infection and to get IV abx. She was sent home on Augmentin. All good care. She had an ortho consult with Dr. X while in the hospital just to make sure there wasn't a hand infection starting. When I see her 24 hrs after discharge, she had a fever and increasing swelling at the puncture wound (on the dorm of the central wrist), with what looked like as abscess starting. So I'm concerned of a deeper infection starting. No knavel signs....but still the fever and pain and getting worse. So......I call the ortho who is on call. It is Friday afternoon about 2 pm. I go ahead and describe the issue, happened to mention the patient saw his fellow ortho colleague in the hospital. Right then the ortho on call stopped me from speaking and said... "I'm going to have you break protocol right now and have you call Dr. X who saw the patient . That way there is continuity of care. Dr. X is working at the outreach clinic 30 miles away. You can call him instead." Then he hung up. Of course, I could not for the life of me get a hold of Dr. X. Nope, he was done with his outreach clinic at noon, and who knows where he is...he is not on call....why would he answer any page???? In the end I just managed it on my own, gave the pt another dose of IV ABX in the clinic , arranged for follow up at Sat. clinic and told her if she got worse overnight to go immediately to the ER. Then I documented the crap out of my note to the detail that the ortho on call wouldn't take my call and the other ortho was nowhere to be found. I sure hope I don't get scorched on this one..... Link to comment Share on other sites More sharing options...
Reality Check 2 Posted February 12, 2017 Share Posted February 12, 2017 I had to take a clinic patient who needed to be taken to the OR planted in the ER and have the ER doc call the on call until he freaking showed up in the ER to see the problem - then the jerk had the nerve to ask why it had taken so long. He wouldn't come see the patient for me based on my call and HEAVY ortho background but final gave in to a doc who made more noise and had the MD behind his name. Sucked 100%. Patient was ok. Surgeon got away with being a PRIC&. On the same note, the meh ER saw the septic elbow I sent over and tried to handle it themselves and D/C pt on orals. When he went septic, dropped his pressure and became a tad obtunded - they FINALLY called ortho. He had been in the ER for 4 hours growing his systemic illness. Ortho doc, a truly good guy, went ballistic and called the head of the ER group, the head of the hospital and then called me - he is speed dial now and I can bypass the ER.... Crappy folks of all ranks in all specialties. Hopefully the rest of us outnumber them and do right by the patient. Link to comment Share on other sites More sharing options...
nixietink Posted February 12, 2017 Share Posted February 12, 2017 I had a patient scheduled to be seen for follow up of a cat bite to her wrist. The pt. was hospitalized overnight due to the infection and to get IV abx. She was sent home on Augmentin. All good care. She had an ortho consult with Dr. X while in the hospital just to make sure there wasn't a hand infection starting. When I see her 24 hrs after discharge, she had a fever and increasing swelling at the puncture wound (on the dorm of the central wrist), with what looked like as abscess starting. So I'm concerned of a deeper infection starting. No knavel signs....but still the fever and pain and getting worse. So......I call the ortho who is on call. It is Friday afternoon about 2 pm. I go ahead and describe the issue, happened to mention the patient saw his fellow ortho colleague in the hospital. Right then the ortho on call stopped me from speaking and said... "I'm going to have you break protocol right now and have you call Dr. X who saw the patient . That way there is continuity of care. Dr. X is working at the outreach clinic 30 miles away. You can call him instead." Then he hung up. Of course, I could not for the life of me get a hold of Dr. X. Nope, he was done with his outreach clinic at noon, and who knows where he is...he is not on call....why would he answer any page???? In the end I just managed it on my own, gave the pt another dose of IV ABX in the clinic , arranged for follow up at Sat. clinic and told her if she got worse overnight to go immediately to the ER. Then I documented the crap out of my note to the detail that the ortho on call wouldn't take my call and the other ortho was nowhere to be found. I sure hope I don't get scorched on this one..... Not sure why you assume this would specifically occur with just ortho. You have people trying to pass the ball in all specialties of medicine unfortunately... Luckily my experience has found physicians like this to be the in the minority. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted February 12, 2017 Share Posted February 12, 2017 Did you call first ortho back? I would've called on-call ortho back, told them I couldn't get hold of initial-care ortho, and this pt needed admitted. If they still didn't want to play then send them to ED. Link to comment Share on other sites More sharing options...
dchampigny Posted February 12, 2017 Share Posted February 12, 2017 If you caved and refused to do anything further, then you are part of the problem too. It's called being an advocate for your patient and generally one of the things that seperates PAs from other professions. Link to comment Share on other sites More sharing options...
Arthropathy Posted February 12, 2017 Share Posted February 12, 2017 The way our service works is the on call team only handles new consults during business hours. Once Team A is consulted they own the patient. If I had recieved this phone call, during business hours, I would recommended the same, although hopefully in a more tactful way. That being said if you were unable to get physician A on the line I would have helped you out. But maybe that is how their service works. If no attempt was made to reach physician A, physician B might be considered to be poaching. Just sayin. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted February 12, 2017 Share Posted February 12, 2017 At some point it is no longer about territory - it is about being a butt. If the person "technically consulted" won't answer, is out of town, is in the OR for the duration, etc etc etc. --- there is a statute of limitations in my opinion. The person on call RIGHT NOW gets tagged. If other attempts have been made then this right now person should be required to buck up and take the hit. No cherry picking. Pus is pus and no one likes it. Too many docs look at it as liability - getting blamed for a bad outcome. Well, pus can have a bad outcome regardless - not like that doc put the pus there. If anything, the on call doc can be the "good guy" and salvage the situation with lots of education about the effects of infection and the risks. Delayed treatment leads to more complications. My note would say "contacted Dr X at 14:55 and he states that since Dr Y had originally seen the patient, it is Dr Y's patient. Dr Y is 75 miles from town at a satellite clinic and is not responding to phone calls. His office is unable to reach him. Called Dr X back and explained the situation. Dr X declines to see the patient at all." Then document that you contacted another specialist and the outcome and then what you did to remedy the situation. Always do right by the patient. That will not read well in court or to a risk manager and won't win Dr X any friends or loyalty. Again, the majority of us in all ranks are not stooges and will take care of people. The outliers who are butts will get their due. They live by referrals and we control the referrals...... I have a short list of ABSOLUTELY DO NOT SEND PATIENTS HERE - and their partners often know it and have improved their relationships with me and their availability to take my patients. What goes around comes around. Link to comment Share on other sites More sharing options...
Incognito Posted February 12, 2017 Author Share Posted February 12, 2017 The ortho office closes at noon on Fridays. I failed to mention my CP was fully aware of my treatment plan. I will find out tomorrow if said patient went to the ED. Link to comment Share on other sites More sharing options...
KMD16 Posted February 13, 2017 Share Posted February 13, 2017 OP. I disagreed with the title of your post. You should never prejudged any specialist. Always keep an open mind. Yes. I agreed. Most/few are a-hole. I will probably do the same. To have you reach out to the initial consultant. However, I would be more nicer and not hanged up. Just out of curiosity. Did anyone order any imaging? Link to comment Share on other sites More sharing options...
CAAdmission Posted February 13, 2017 Share Posted February 13, 2017 If you need someone on-call to show up in the ER, ask them to spell their name so you can get it down correctly in the "EMTALA violation report." They will probably take a hint. Link to comment Share on other sites More sharing options...
Katera Posted February 13, 2017 Share Posted February 13, 2017 I thought the answer to this thread title was to say, "Tom Price" lol Link to comment Share on other sites More sharing options...
BruceBanner Posted February 13, 2017 Share Posted February 13, 2017 Common passing of the buck. Not unique to ortho. No one wants to inherit a train wreck or admission on a Friday afternoon. Just document it like you did and tx it yourself as best you can. Link to comment Share on other sites More sharing options...
TWR Posted February 13, 2017 Share Posted February 13, 2017 All the above good reasons why we need full practice authority with the same respect as an MD. However asking the Butt to spell his name usually gets their attention. Since when was medicine 8-5 and i/2 day on Friday and weekends off?? Link to comment Share on other sites More sharing options...
Incognito Posted February 14, 2017 Author Share Posted February 14, 2017 All turned out ok. The patient went to the Saturday clinic and no abscess, infection nicely clearing up. Plus I did not hang up the phone, the ortho surgeon did. In fact I was so shocked since I worked with this surgeon on a Quality Improvement committee in the past. That particular group has a history of not responding to calls from outlying clinics and have been discussed at the QI meetings, of which he is the chair. Ok, Ok, I will try to be more open minded and not prejudice a specialty. It's the person, not the specialty, gotta remember that! Link to comment Share on other sites More sharing options...
PC2ED Posted February 14, 2017 Share Posted February 14, 2017 I hope you documented that you called the doc on call and he declined to consult with the patient and referred you to the other doc. then document that you could not reach the other doc then let your department's director know about this pushback so he/she can address it and fight for you. Link to comment Share on other sites More sharing options...
sk732 Posted February 15, 2017 Share Posted February 15, 2017 If i makes you feel beter, yesterday I had a lazy urologist not take a patient that needed urethral dilatation because another urologist operated on the patient 14 years ago (and hadn't seen them since) and he considered this an operative complication. The original surgeon wasn't amused when I touched base with them after they'd just got out of an 8 hour surgery... It's not restricted to ortho...there are a lot of knobheads/dolts/asshats spread across the gammit of specialties, even family med. We really need some eye rolling emojis here :-D. SK Link to comment Share on other sites More sharing options...
Evolute Posted February 16, 2017 Share Posted February 16, 2017 If the person "technically consulted" won't answer, is out of town, is in the OR for the duration, etc etc etc. --- there is a statute of limitations in my opinion. The person on call RIGHT NOW gets tagged. If other attempts have been made then this right now person should be required to buck up and take the hit. No cherry picking. I couldn't agree more. If a pt tells me they have been seeing a specialist for their medical problem, I try to call that person first. If I cant contact them within a certain time frame then I call the person on call and tell them I made attempts to contact Dr. X without success and I need your help/advise. That way it takes away the argument of "call Dr. X...... Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.