jmj11 Posted August 1, 2012 Share Posted August 1, 2012 This situation came up last week and I wanted to see how others would react. I've already made my decision so I'm not looking for how I should handle it but just one of those quirky social surveys of how PAs in general would. Dr. X (neurologist) sees Mr. Thompson. He is a 59 year on man with a new (times 2 months) onset of a daily bitemporal headache. Dr. X diagnoses him as chronic tension type headache and puts him on amitriptyline. The patient takes it for a month with no benefit and returns to Dr X. Dr. X (who has confined with me many times that he can't stand headache patients) decided to refer him to my clinic. I see Mr. Thompson. While new daily (primary) headaches can come on suddenly at any age, it is a red flag. As I carefully went through the story the patient also had no family history of headache and in his ROS, he reported a general ill feeling for the past few months and being "achy." In my exam, I noticed some general tenderness of his shoulder girdle, trapez muscle and pects. I ordered a Sed Rate and CRP. The sed rate came back at 55. Because of his unusual age (for TA or PMR) and the fact that Rheumatology could see him in two days, I didn't start him on steroids or attempt a TA bx (it takes our surgeons two weeks to work them in). It has been a month since I saw Mr. Thompson. Last week I got a letter, addressed to Dr. X but cced to me from the rheumatologist. "Dear Dr. X" Thank you for your kind referral of this nice man. We were able to get TA bx and confirmed a diagnoses of TA (Giant Cell Arteritis) as well as PRM. I have just started him on a steroid program and will follow him from this point forward. It was a great pick up of yours and thanks again for the referral. Sincerely, Dr. B (rhematologist) cc PA Jones" So it comes down to a. defending yourself and your profession or b. being paranoid. That's the two ends of the spectrum. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 1, 2012 Moderator Share Posted August 1, 2012 I would send a email back CCing both and ask DrX how did he make such a great catch. That is if I knew Dr. X well enough to know he wouldn't take offense. I'm interested I know how you did it. Link to comment Share on other sites More sharing options...
jmj11 Posted August 1, 2012 Author Share Posted August 1, 2012 So how much of this becomes a personal issue, wanting to be acknowledged for what you have done, and how much of it is related to keeping our profession in the best light, which it deserves? I think, when it doesn't come across as insecurity, and can be done in a simple way, that we should let wrong information, who made the diagnosis, known. But that's the discussion point. I will state what I did later. Link to comment Share on other sites More sharing options...
cinntsp Posted August 1, 2012 Share Posted August 1, 2012 As much as I would want to make it clear that it was my catch, I would take the high road and then hope Dr. X did the same. Link to comment Share on other sites More sharing options...
d2305 Posted August 1, 2012 Share Posted August 1, 2012 If the neurologist is a good referral source for you, it would be prudent to make waves. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 1, 2012 Administrator Share Posted August 1, 2012 I'd privately ask Dr. X if he would be willing to correct the neurologist and cc: you on the correspondence. Dr. X may or may not be willing to do so... depending on whether he wants more headache patients or not. :-) In other words, always come up with a reason for someone else to do the right thing besides just "it's the right thing to do". For those MDs whose ethics are greater than their ego, it's unnecessary. For others... it's a worthwhile incentive. Link to comment Share on other sites More sharing options...
ToppDog Posted August 1, 2012 Share Posted August 1, 2012 Maybe a quick thank you response as if you naturally mistook the email to have been addressed to you & cc'd to the other doc :) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 1, 2012 Moderator Share Posted August 1, 2012 Maybe a quick thank you response as if you naturally mistook the email to have been addressed to you & cc'd to the other doc :) excellent idea.... Link to comment Share on other sites More sharing options...
jmj11 Posted August 1, 2012 Author Share Posted August 1, 2012 Simply what I did was send the rheumatologist my notes from the original visit. We referred the patient but they never asked for our notes, only the notes from the neurologist. So I just sent a note, "Thank you for following my patient" and "Attached are my original notes" and attached them. That's all. But I hope it clarifies the situation. But I'm sure you must run into this where your SP gets credit or others. I think it is a fine balance to make sure they know that PAs make these diagnoses without taking it personal. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 2, 2012 Moderator Share Posted August 2, 2012 sorry about the tone that this message gave. im not challenging your motives, or trying to preach. my thoughts were essentially that theres no reason to feel bad about wanting recognition. it helps you on so many levels, and even if it were just an ego boost, even that is enough for me. nice post as the first one came across really wrong - especially from a non pa.... JM - well played - might just keep that one as a little point to correcct in the future - in casual conversatin with the refering neuro you could just make light and a joke that you should get an atta boy for making him look good!! lets him know that you were aware of the error but you let him take th glory on this one As for the rheum/surgeon - harder one on that - likely a great play to have sent notes - hope they read them - you might CC them a follow up note (if you are going to see him in F/U for his head aches?) documenting that you had seen him after Neuro and you had referred him to them.... on this issue - the other day I was told that oral pred does not affect the results of the TA Bx - seems like it would - which is the truth? Link to comment Share on other sites More sharing options...
Joelseff Posted August 2, 2012 Share Posted August 2, 2012 Simply what I did was send the rheumatologist my notes from the original visit. We referred the patient but they never asked for our notes, only the notes from the neurologist. So I just sent a note, "Thank you for following my patient" and "Attached are my original notes" and attached them. That's all. But I hope it clarifies the situation. But I'm sure you must run into this where your SP gets credit or others. I think it is a fine balance to make sure they know that PAs make these diagnoses without taking it personal. My SP gets all the labs I order despite me circling my name on the lab req. He also gets ALL the calls from consulting docs even though I referred the pt and signed the referral. My SP dislikes it also and we are going to take an afternoon off to visit the consulting docs we use most to introduce me to them and let them know that i have my own case load. Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
jmj11 Posted August 2, 2012 Author Share Posted August 2, 2012 the other day I was told that oral pred does not affect the results of the TA Bx - seems like it would - which is the truth? This has been widely debated. The rheumatologists at Mayo told us, prednisone up to 10 days to 2 weeks is okay, after that, false negatives are possible with the Bx. Link to comment Share on other sites More sharing options...
Roger Pittman Posted August 27, 2012 Share Posted August 27, 2012 I had this happen many times in my 30+ years as a PA. The first time it happened was in a ED when I corrected a ED physician's Dx to acute MI (when we were along). He had failed to notice the acute changes on the EKG. He went ballistic in front of the Pt. and nurses. The cardiologist confirmed my Dx and the Pt. was admitted to CCU and underwent CABG later that afternoon. The ED MD though wanted me fired or hung because I disagreed with his ED DX. The most important outcome of this kind of situation is that the Pt. knows and in this case knew what has going on. He and his wife came by the clinic after he was discharged and cried about how I had saved his life. I have saved many lives since then, I still take the same road. Don't be afraid to disagree with a physician, don't do it is front of the Pt., and stand our ground. Link to comment Share on other sites More sharing options...
rcdavis Posted August 27, 2012 Share Posted August 27, 2012 So, how did the rheumatologist even know about the neurologist??? I suspect that this is an unintended consequence of simply dictating a note based on the patient's initial paperwork.. Where he answered "who is your regular physician?", I'll bet he filled in the neurologist's name. The rheumatologist probably didnt even ask the sequence of who made the diagnosis history... And, unless the patient told him, is unlikely would know the neurologist's name. Other possibility is te the rheumatologist thinks that you are still working with the neurologist... And assumed y'all were working together. A quick note to him reiterating that you are solo now might be in order.. He is probably looking at the neurologist as the referral source ... Of course, rhematologists can be real dick$ ... Mike, as an aside, I would think that there is some liability to NOT starting TA pts on steroids... I wrestle with this all the time in he ED.. is EASY if the pt is insured, but 65% og my patients are uninsured... And getting ED f/u can be a bear... Especially after 2200.. Which is when I see them. So.. If TA is high on my list, they all get high dose steroids with the written referral ... Telephone calls always are "sure, have the pt come in", but when they arrive there is that pesky $200-250 up front cash deposit that they are asked for, and cannot pay. I'd rather have treated and been wrong than otherwise. One blind pt is one too many. Link to comment Share on other sites More sharing options...
Hemegroup Posted October 8, 2012 Share Posted October 8, 2012 Maybe a quick thank you response as if you naturally mistook the email to have been addressed to you & cc'd to the other doc :) excellent idea.... ....... i third! Credit where credit is due. If there was one thing that was drummed into my head in PA school, it's DOCUMENT DOCUMENT DOCUMENT. For ANY number of reasons it's important to properly document this situation, not the least of which is to protect you, your SP, the patient, the specialist, et al. No ego issues involved, simply plain ol' scientific and statistical accuracy. Link to comment Share on other sites More sharing options...
ncorthopa Posted October 17, 2012 Share Posted October 17, 2012 This has happened to me before and I never saw the need to take credit. I just don't see the point. And I am not trying to be preachy either but it seems like a pride thing to need the credit. And as far as the PA profession goes I think it would be counter productive... Link to comment Share on other sites More sharing options...
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