Moderator ventana Posted March 28, 2022 Moderator Share Posted March 28, 2022 On call this weekend call group is 3-4 practices with 12-14 providers. Maybe 15000 patients. >50% of patients that called in for various complaints and needs were on some type of controlled substance (good hospital system with EMR, contracts and good follow up) these we not patients looking for meds but just calling with questions about healthcare issues. Some were reasonable some weee stupid ( ie I got a cold last night what do I do) over 50% were on controlled sub. was this just a weird weekend? other PA that take call notice this?(think I am the only PA or NP in this whole system that takes full call just like a doc so I can’t ask other PA in my system). others aware of this? deals with health education. ? Societal inputs? entitlement? boredom( me for noticing and patient for calling in?) Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted March 28, 2022 Share Posted March 28, 2022 My pessimistic view is that we have become a helpless society where everyone wants to medicate all their troubles away. 2 1 2 Quote Link to comment Share on other sites More sharing options...
Hemmingway Posted March 28, 2022 Share Posted March 28, 2022 I don't pull call anymore (thank you ) but when I was in a private practice we had shared call. Not one time in all the years I took call did I get a call with a real need I could help with. The most stupid ones just defied any common sense. We were a rural health care clinic in a small town and I had a drunk call me one Saturday night (morning) at 1AM. There was clearly some kind of hillbilly hootananny going on and he want to get maw-maws BP meds refilled. When I was clearly still mostly asleep he held the phone away from his face and yelled to the crowd.... he sounds like he was asleep! This was pre-ehr so the answer was always either go to the ER or call the office during business hours. I concur with the assessment most have lost their ability for any self care. It never ceases to amaze the number of people that come in with a simple problem and when I ask what they have been doing for their problem at home the answer is "nothing." I'm talking colds and simple aches and pains. Also I tell people with a URI to treat their symptoms they ask "with what?" or "how?" Quote Link to comment Share on other sites More sharing options...
LKPAC Posted March 28, 2022 Share Posted March 28, 2022 I don't prescribe meds on-call, especially controlled. Go to ER, UC, or make an appointment 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted March 29, 2022 Administrator Share Posted March 29, 2022 Why do people even take call from patients? I can understand specialists taking call from UC or ER providers, but why do we keep holding on to this vestige? Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 29, 2022 Share Posted March 29, 2022 29 minutes ago, rev ronin said: Why do people even take call from patients? I can understand specialists taking call from UC or ER providers, but why do we keep holding on to this vestige? Because it looks/sounds good for patients and makes them feel better that a provider is always available at their whim...therefore administrators require it instead of putting an iota of responsibility on the patient...because that would simply be asking too much. Do I sound salty? ...and I don't even take call...never have. The funny part...get rid of the call and tell the patient to go to the UC for their concerns. That would actually increase billing, decrease provider burnout (like admin cares), decrease unbillable patient contacts, etc...but NOOOOOO...we must make the patient feel good. Quote Link to comment Share on other sites More sharing options...
Hemmingway Posted March 29, 2022 Share Posted March 29, 2022 Some insurance contracts require you to have 24/7 response/call. 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted March 29, 2022 Administrator Share Posted March 29, 2022 1 hour ago, sas5814 said: Some insurance contracts require you to have 24/7 response/call. Ah, good. I was worried it was some sort of a requirement somewhere I hadn't been able to find. Not taking insurance gives me so much more freedom to ignore BS requirements and keep costs lower, but I want to make sure I'm not violating any regulations. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 29, 2022 Author Moderator Share Posted March 29, 2022 23 hours ago, LKPAC said: I don't prescribe meds on-call, especially controlled. Go to ER, UC, or make an appointment controlleds on call is a hard no - company policy. hard stop. 16 hours ago, rev ronin said: Why do people even take call from patients? I can understand specialists taking call from UC or ER providers, but why do we keep holding on to this vestige? I ask myself the same thing. see below 15 hours ago, mgriffiths said: Because it looks/sounds good for patients and makes them feel better that a provider is always available at their whim...therefore administrators require it instead of putting an iota of responsibility on the patient...because that would simply be asking too much. Do I sound salty? ...and I don't even take call...never have. The funny part...get rid of the call and tell the patient to go to the UC for their concerns. That would actually increase billing, decrease provider burnout (like admin cares), decrease unbillable patient contacts, etc...but NOOOOOO...we must make the patient feel good. Insurance companies require it. Maybe it is good/helpful but really it is 95% BS. I think this regulation was developed like 100 years ago and the insurance companies don't want to let it go. With the availability of UC/Express care and now online health care UC it is insane to have us being on call. But then again the on call PCP answers the question for free and the insurance company loves getting us to do stuff for free. Maybe that is why... Costs them $$ if the patient goes to urgent care. 4 hours ago, sas5814 said: Some insurance contracts require you to have 24/7 response/call. yup Yeah, insurnace company don't have policy that effects the delivery of care. nah... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2022 Moderator Share Posted March 29, 2022 16 hours ago, mgriffiths said: The funny part...get rid of the call and tell the patient to go to the UC for their concerns. That would actually increase billing, decrease provider burnout (like admin cares), decrease unbillable patient contacts, etc...but NOOOOOO...we must make the patient feel good. and INCREASE burnout for UC/ER providers. We don't want to see that stupid stuff either. That is soul sucking stuff right there. Stuff I have had referred to the ER over the years: obvious colds, hangnails, splinters easily removed, chapped lips, seeing spots after looking at bright light, requests for RX for otc meds, pregnancy tests, uncomplicated bug bites, chronic problems that are unchanged and have existed for > 5 years, etc, etc, etc I know I am speaking to the choir here, but the ER should not be a substitute for outpatient visits for lazy PCPs for clearly nonemergent conditions. 2 2 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 29, 2022 Share Posted March 29, 2022 6 minutes ago, EMEDPA said: and INCREASE burnout for UC/ER providers. We don't want to see that stupid stuff either. That is soul sucking stuff right there. I don't think this would actually increase the total visits to UC/ER. If someone is going to go to the UC/ER they're going to go...regardless. If it was a real problem, calling on-call was a waste of time. If it's not a real problem, they probably would have skipped the on-call anyway. 7 minutes ago, EMEDPA said: I know I am speaking to the choir here, but the ER should not be a substitute for outpatient visits for lazy PCPs for clearly nonemergent conditions. Couldn't agree more. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2022 Moderator Share Posted March 29, 2022 1 minute ago, mgriffiths said: I don't think this would actually increase the total visits to UC/ER. If someone is going to go to the UC/ER they're going to go...regardless. If it was a real problem, calling on-call was a waste of time. If it's not a real problem, they probably would have skipped the on-call anyway. Couldn't agree more. I see patients every day who just call their PCP for reassurance and would not have come in if their regular provider had said " take some tylenol and drink lots of fluids" instead of "go to the ER just to be on the safe side". 1 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 29, 2022 Share Posted March 29, 2022 8 minutes ago, EMEDPA said: I see patients every day who just call their PCP for reassurance and would not have come in if their regular provider had said " take some tylenol and drink lots of fluids" instead of "go to the ER just to be on the safe side". But that's my point. Even with contacting on-call they came in. So, if the on-call provider wasn't available, either they would come in anyway or they wouldn't have come in. With the on-call provider they 100% came in. It's CYA and/or lazy medicine (not necessarily different) and it's not right. Quote Link to comment Share on other sites More sharing options...
Hemmingway Posted March 29, 2022 Share Posted March 29, 2022 22 minutes ago, EMEDPA said: I see patients every day who just call their PCP for reassurance and would not have come in if their regular provider had said " take some tylenol and drink lots of fluids" instead of "go to the ER just to be on the safe side". Having spent a couple of years in the ER I understand what you are saying. However in todays sue-happy society giving advice over the phone to someone you haven't evaluated (and may have never seen if its someone else's patient) has some legal exposure issues. I live and die by follow up instructions. I'm old enough to remember when we gave on-call advice and didn't even chart it or make a note. Later in my professional life I kept "on call" slips near the phone so I could document all patient's ID, what they called about, my exact instructions, and the notation they indicated their understanding. Now most people could do it on an EHR accessed from home. That said if you make a process idiot proof someone will make a better idiot. 1 2 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2022 Moderator Share Posted March 29, 2022 5 minutes ago, sas5814 said: That said if you make a process idiot proof someone will make a better idiot. Yup. We have a hemoglobin tester in Haiti that is "idiot proof". Put 2 drops of blood on sensor. Done. We started getting a lot of really low levels and found someone was using a drop of blood and a drop of water when they couldn't get enough blood with a finger stick.... 3 2 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 29, 2022 Author Moderator Share Posted March 29, 2022 1 hour ago, EMEDPA said: and INCREASE burnout for UC/ER providers. We don't want to see that stupid stuff either. That is soul sucking stuff right there. Stuff I have had referred to the ER over the years: obvious colds, hangnails, splinters easily removed, chapped lips, seeing spots after looking at bright light, requests for RX for otc meds, pregnancy tests, uncomplicated bug bites, chronic problems that are unchanged and have existed for > 5 years, etc, etc, etc sounds like my regular day in the office.... LMAO 1 hour ago, EMEDPA said: I know I am speaking to the choir here, but the ER should not be a substitute for outpatient visits for lazy PCPs for clearly nonemergent conditions. Yeah, but when admin and society dumps on the front line PCP workers and it is after hours, that poop flows downhill to your UC/ER Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2022 Moderator Share Posted March 29, 2022 14 minutes ago, ventana said: Yeah, but when admin and society dumps on the front line PCP workers and it is ANYTIME AT ALL, that poop flows downhill to your UC/ER fixed that for you. 430 pm on a friday? an afebrile URI is an emergency. Noon any day of the week? Go to the ER... 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 29, 2022 Author Moderator Share Posted March 29, 2022 ouch busted me on that one.... 2 Quote Link to comment Share on other sites More sharing options...
cc56 Posted March 31, 2022 Share Posted March 31, 2022 On 3/29/2022 at 3:22 PM, EMEDPA said: and INCREASE burnout for UC/ER providers. We don't want to see that stupid stuff either. That is soul sucking stuff right there. Stuff I have had referred to the ER over the years: obvious colds, hangnails, splinters easily removed, chapped lips, seeing spots after looking at bright light, requests for RX for otc meds, pregnancy tests, uncomplicated bug bites, chronic problems that are unchanged and have existed for > 5 years, etc, etc, etc I know I am speaking to the choir here, but the ER should not be a substitute for outpatient visits for lazy PCPs for clearly nonemergent conditions. I know we all have a "crap" part of our jobs. I see all the people that e-mail their providers to basically get a full visit with prescriptions over e-mail. That has to be frustrating for all of you who do PCP/IM! I will also see that the PCP can't get them in sometimes and e-mails back saying to go to UC...... but they show up to the ER. Then when I say you have a cold, go home, and Tylenol/Motrin/hydrate/rest/etc... They argue their doctor always gives them an antibiotic and they need the "strong one". As EMEDPA said it can be so soul sucking sometimes. EMEDPA I wonder how often the patient says "my doctor sent me", but they realized in the ER how stupid their complaint is and they realize they look like a moron if they came in on their own accord? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 31, 2022 Moderator Share Posted March 31, 2022 1 hour ago, cc56 said: EMEDPA I wonder how often the patient says "my doctor sent me", but they realized in the ER how stupid their complaint is and they realize they look like a moron if they came in on their own accord? nah, they always feel their visit is justified if their doc sent them in. The ones who gripe are " I am only here because my spouse/SO/Partner sent me in". Interestingly, those folks are usually sicker than the doc referrals. 2 Quote Link to comment Share on other sites More sharing options...
doubledose Posted April 1, 2022 Share Posted April 1, 2022 As a PCM can verify lots of stuff sent to ER that is mostly not ER worthy. Honestly, the patient insisting that they have a real issue but wait time is 3-4 weeks for appointment and everyone knows that most illnesses are resolved by this time, so patient is adamant it is urgent or emergent (attempt to get ahead of the line) so the only logical call is UC/ER unless it can wait 3-4 weeks. Sometimes I can review notes from ER and the phrase "sent to ER by PCM" is primary reason. Always makes me laugh. When I feel the issue is real I get a specialist on the phone and get them in with said specialist to avoid ER visit, but only do this for the patients in clinic as I can verify a complaint with PE... not a fan of telemed. Caught too many mistakes after patient comes in - like otitis media that was thought to be congestion or pneumonia initially diagnosed as URI. Solution? Glad you asked; more practioners could decrease wait time but who wants to pay for more providers? Just see more patients is usual solution. Oh wait, they now need follow up care, which doesn't change anything for the extra couple of appointments. UC is the future unless some one puts 2 + 2 together... 1 Quote Link to comment Share on other sites More sharing options...
Hemmingway Posted April 1, 2022 Share Posted April 1, 2022 10 hours ago, doubledose said: so patient is adamant it is urgent or emergent (attempt to get ahead of the line) they used to do that in the UC and it usually landed them in the ER because they fluffed their complaint 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 1, 2022 Moderator Share Posted April 1, 2022 1 hour ago, sas5814 said: they used to do that in the UC and it usually landed them in the ER because they fluffed their complaint How long have you had this 10/10 ripping/tearing pain in the center of your chest sir? 25 years, he says (while texting on phone and eating an egg mcmuffin) and I am sick of it! 2 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted April 1, 2022 Share Posted April 1, 2022 Truth be told, the suits in the c-suite probably love all the trivial crap. Imagine the revenue loss if only emergencies went to the ER. No more $800 splinter removals. 1 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted April 2, 2022 Share Posted April 2, 2022 9 hours ago, EMEDPA said: How long have you had this 10/10 ripping/tearing pain in the center of your chest sir? 25 years, he says (while texting on phone and eating an egg mcmuffin) and I am sick of it! I've had similar when covering at UCs...those are the patients where I then step out and leave them in the room while I see pretty much everyone else. Quote Link to comment Share on other sites More sharing options...
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