maybe things are taking a turn for the better....

[EMEDPA]

So I need to keep this a bit vague, but interesting story.

I had a pt recently with a significant traumatic injury who was not appropriate to keep at my rural , critical access hospital. I called one of the regional trauma ctrs(on a recorded line) and got a physician on the phone who is well known for not liking PAs. I presented a straightforward case about wanting to transfer the pt to a higher level of care for surgical evaluation and possible intervention. The physician started giving me the third degree and telling me how this was an inappropriate transfer because "most people with this injury don't require operative intervention". I pointed out that I was in a very small ED with minimal resources for trauma more than an hour away from a facility with a trauma surgeon. the physician told me to "talk to my IR department" to which I responded that we don't have one. I told the doc 5 or 6 times: the staff here is me, a handful of nurses, an xray tech, a lab tech, and an on-call fp physician who would never consider admitting a pt for observation of this particular injury. the doc then said" well let me talk to the ED physician then because you are just the PA". repeat of prior conversation. I had to resort to mentioning I knew the chief of trauma at the facility in question and they had asked me to send this type of pt to them before. after a 10 min conversation that should have lasted 2, the doc accepted the transfer. after they got off the recorded line, the transfer coordinator still on the line started apologizing. the next day I got a call from the chief medical officer of that hospital, who said he had reviewed the recording, apologized and assured me I would not have to deal with that behavior again. EM PA 1, Asshat surgeon zero. about time. behavior like this surgeon's used to be standard practice. this surgeon hit every benchmark for being the stereotypical surgeon during our call. they were belittling, condescending, and dismissive of my request, mostly because I was a PA. glad someone finally decided that this was not acceptable behavior. I did not need help making the decision to transfer. this was not a request for consult. I know my resources and knew this pt could quickly exceed them. I think this is probably the first time in 31 years that I have ever gotten an apology about this kind of behavior. maybe things are looking up.

[SoCal_PA]

I like it. Maybe this would be better suited for the general discussion sub so more people can see it?

[KMD16]

Good work!

[Ghazni]

legacy? or Ohsu?, anyway im glad the cmo got your back.


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[EMEDPA]

3 minutes ago, Ghazni said:

legacy? or Ohsu?, anyway im glad the cmo got your back.


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neither, I am in WA. 

[Acromion]

For what it's worth, I've known surgeons to treat ER docs in the exact same way. You being a PA was simply one of many excuses he could conjure up for him to reject the transfer he knew full well was his responsibility to accept. I'm sure he didn't even care you were a PA. If you were an ER doc, he would probably find some other reason to demean you. During my stint in a rural ER, I've witnessed some real knock down drag out fights between supervising docs and consultants. I've been on the receiving end of many consults like that, and it's water off the ducks back for me. I had one patient who had essentially degloved the majority of his forearm after falling off a ladder. Surgeon rejected the transfer on the basis that there were no neurovascular injuries so it could be repaired in the ER with surgical follow up. Supervising doc got on the phone and it escalated into a screaming match, with the surgeon accusing the doc of "abusing the system" by turfing such patients to their trauma center. Well the ER doc lost that fight end we ended up spending over 2 hours painstakingly suturing together this guys mutilated forearm, in addition to attending to his other minor injuries from falling from 15-20 feet. That one patient log jammed the ER all night long. My second ER job in a well staffed larger community suburban hospital was a totally different experience. Admissions and transfers were like butter. Many of the consultants seemed eager to take our softball admits. 

I try to keep in mind that these surgeons are under a lot of stress, and perhaps they've had an exceptionally bad day. Sometimes I would see them later in the ER and they are perfectly congenial ... and once in a blue moon they will apologize for one of their temper tantrums. I just see this as par for the course with surgeons.

[EMEDPA]

I have had just the opposite experience. docs from multiple services at urban ctrs refused admits and transfers daily. aside from this one asshat, I have had no problems in over a decade working in several different rural EDs. 

[Boatswain2PA]

9 hours ago, Acromion said:

Supervising doc got on the phone and it escalated into a screaming match, with the surgeon accusing the doc of "abusing the system" by turfing such patients to their trauma center. Well the ER doc lost that fight end we ended up spending over 2 hours painstakingly suturing together this guys mutilated forearm, in addition to attending to his other minor injuries from falling from 15-20 feet.

Wow...Does your shop have any trauma designation (level 2,3 or 4)?

I would have handled it differently by asking a$$hat surgeon if he is formally refusing transfer.  If so, document as such and find a different trauma center to send them to.  I often work 200+ miles from closest tertiary care but can ship to multiple trauma centers if necessary (in different directions).

Emed - I had similar story recently with a geriatric septic colitis patient.  2 day hx of abd pain and diarrhea, febrile, tachy, leukocytosis, and elevated lactate.  Intensivist at mother-hospital didn't want to accept because "there was no source" of infection to call it sepsis.  Finally told him "this meets sepsis criteria in anyone's book, are you accepting transfer or not?".  Chief of Staff later talked with Medical Director at mother-hospital who listened to recorded line and sent apologies to me.

I love recorded lines!

 

[sas5814]

I just ask if they are familiar with EMTALA. I'm not arguing. This is the patient. It is beyond our means. I need to elevate this to a higher level. Period. Don't accept? NP. Transfer to different facility and EMTALA complaint filed.

I'm too old and cranky to argue with this asshats anymore.

[ventana]

recorded lines are great as long as we know our stuff, and present well

 

then we can use to our advantage.....

 

 

strong work all!!