GMM2019 Posted July 22, 2020 Share Posted July 22, 2020 I'm hoping for a little advice from experienced PAs on how to handle this situation. I've been seeing patients independently in neurology for a few months now after a training period. Sometimes I'll end up with these autonomic dysfunction patients who really need to be evaluated and managed by the autonomic sub-specialist. The problem is that the one sub-specialist in our hospital system refuses to see these patients unless they have autonomic testing done first. There are quite a few problems with ordering the autonomic testing (includes skin biopsy for small fiber neuropathy). My supervising physician never really orders it, so she is not familiar with managing the results. I don't know how to interpret it, so it doesn't help me with my clinical decision-making. The autonomic testing is almost always abnormal... so then patients walk away from it thinking they have all these diagnoses that they probably don't have. Even after the patients get the testing, they can't get an appointment with the autonomic specialist for 6 months to 1 year to act upon the results... so then the person who ordered the testing is stuck with managing the results and trying to explain it to the patient. The results aren't even sent to my inbox when they are finalized, so I don't even know when a patient gets the testing done. I will get frantic calls and messages from patients asking about these results that I can't even explain to them. The only reason to order the testing would be so the specialist accepts them, but I don't really want to be responsible for the results. I really think the autonomic specialist should be the one ordering it if he's making clinical decisions based off of it. I have received messages from some of the office staff and manager asking me to order the autonomic testing for patients... but I really don't want to. It's my license... I should get to call the shots on what I order. I can just refer patients to a specialist at a different hospital in the same network who does not require the testing first. I don't want to order this test again going forward. I have had so many bad experiences with it so far. What would you do in this situation? Would you just stay quiet and order the testing? I can't really get a clear answer from my SP about what to do. Quote Link to comment Share on other sites More sharing options...
Joelseff Posted July 22, 2020 Share Posted July 22, 2020 I'll quote you: "I can just refer patients to a specialist at a different hospital in the same network who does not require the testing first. I don't want to order this test again going forward."Sounds like a great solution to me! Sent from my SM-G975U using Tapatalk 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 22, 2020 Moderator Share Posted July 22, 2020 Sounds like the subspecialist has more business than he wants, so send them elsewhere. When his business dries up, whoops, sorry, my patients are really happy elsewhere. 1 2 Quote Link to comment Share on other sites More sharing options...
SedRate Posted July 23, 2020 Share Posted July 23, 2020 Agree with above: refer elsewhere. 1 Quote Link to comment Share on other sites More sharing options...
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