My Personal Record
Most calls required to find an accepting physician: 13
This sequence began at 3am. My patient had a nasty fracture/dislocation of the wrist.
1) Ortho on call: "I don't do wrists. Call the Hand guy on call (Plastic Surgery)."
2) Hand Surgeon on Call, Dr. Lunate: "This is the answering service for Dr. Lunate. Please leave a message after the tone and your call will be returned."
3) 30 minutes later, no response. Left another message.
4) 30 minutes later, no response. I call him at home and leave a message on his answering machine.
5) Plastic Surgeon on call (but not for hands): "I don't do wrists. Sorry."
6) Plastic Surgery Resident: "I don't think Dr. Lunate is on the teaching service. But try this number...###-####."
7) ###-####: "This number is no longer in service."
8) Medical Director of the hospital: "You should call the Chief of Plastic Surgery. No, I don't know who that is."
9) Charge Nurse of the ER (I had to call her because she was in her office somewhere, not on the unit): "No, I don't know who the Chief of Plastic Surgery is, but I'll find out!"
10) Chief of Plastic Surgery, Dr. Beautaux: "I'm in New York for a Big Plastic Surgery Meeting. So are most of our Plastic Surgeons, in fact. It's a Really Big Meeting. Try the Chief of the Hand Service, Dr. Synovitis.
11) Plastic Surgeon who is covering for Dr. Synovitis (who is probably at the Really Big Meeting too, I suspect): "I don't do wrists, sorry. You might try Dr. Dikhed."
12) Dr. Dikhed, Plastic Surgeon: yells at me, because he is "not working this weekend!!!!!" (so why did you even answer your pager at 6 am?)
13) My last resort, Dr. Gohtew, with my favorite Orthopedic group (even though they are not on no-doc call), and who I really didn't want to abuse with this EMTALA special, but I was running out of options: "Well, I'll come down and look at it. If I can't fix it, I'll try to find someone who can." (YES!!!!!)
Then at 8 am, 5 hours after I made my first telephone call, Dr. Lunate (the hand surgeon on call) finally calls back and accepts the patient. I was so grateful to finally make the disposition that I never said a word to him about the delay.
This sequence began at 3am. My patient had a nasty fracture/dislocation of the wrist.
1) Ortho on call: "I don't do wrists. Call the Hand guy on call (Plastic Surgery)."
2) Hand Surgeon on Call, Dr. Lunate: "This is the answering service for Dr. Lunate. Please leave a message after the tone and your call will be returned."
3) 30 minutes later, no response. Left another message.
4) 30 minutes later, no response. I call him at home and leave a message on his answering machine.
5) Plastic Surgeon on call (but not for hands): "I don't do wrists. Sorry."
6) Plastic Surgery Resident: "I don't think Dr. Lunate is on the teaching service. But try this number...###-####."
7) ###-####: "This number is no longer in service."
8) Medical Director of the hospital: "You should call the Chief of Plastic Surgery. No, I don't know who that is."
9) Charge Nurse of the ER (I had to call her because she was in her office somewhere, not on the unit): "No, I don't know who the Chief of Plastic Surgery is, but I'll find out!"
10) Chief of Plastic Surgery, Dr. Beautaux: "I'm in New York for a Big Plastic Surgery Meeting. So are most of our Plastic Surgeons, in fact. It's a Really Big Meeting. Try the Chief of the Hand Service, Dr. Synovitis.
11) Plastic Surgeon who is covering for Dr. Synovitis (who is probably at the Really Big Meeting too, I suspect): "I don't do wrists, sorry. You might try Dr. Dikhed."
12) Dr. Dikhed, Plastic Surgeon: yells at me, because he is "not working this weekend!!!!!" (so why did you even answer your pager at 6 am?)
13) My last resort, Dr. Gohtew, with my favorite Orthopedic group (even though they are not on no-doc call), and who I really didn't want to abuse with this EMTALA special, but I was running out of options: "Well, I'll come down and look at it. If I can't fix it, I'll try to find someone who can." (YES!!!!!)
Then at 8 am, 5 hours after I made my first telephone call, Dr. Lunate (the hand surgeon on call) finally calls back and accepts the patient. I was so grateful to finally make the disposition that I never said a word to him about the delay.
Labels: ER, nightshifts
posted by scalpel at 12:20 AM
24 Comments:
Glad that worked out for you. that stuff must really tie you guys up when you are busy.
Loved the nicknames! :)
tie us up when busy? dam right. And I get yelled at by consultants when I page them to the main number and not "the phone where I'm standing" b/c they don't have time to be put on hold.
Apparently, though, I have time to "stand."
I thought that this type of thing only happened to nurses. Until I started reading Doc blogs, I never knew how pervasive this type of behavior was within the medical community. I'm sorry you have to deal with this type of behavior while you are trying to ease the suffering of your patients.
Ouch, crescendo frustation there. That crap happens to us in Internal Medicine all the time. What's worse is that you can't even show your increasing irritation with each phone call because nobody knows or cares about the ones leading up to their own.
OMG, ever try getting a patient with facial & mandible fractures hooked up with a surgeon for an IMF. It's a game of musical chair and patient punting between several services including:
Plastics
OMFS
ENT
"Oh, the orbits are involved, too? That's opthalmology man!"
Same ol' sh*t every freakin' shift with these guys, ya know. Funny thing is, they never get tired of playing patient hot potato.
Maybe I am being naive,but if they're "on call" and they KNOW you are an ED doc in a BUSY ED that needs to keep patient flow going and of course the PATIENT who is in pain, you would think they would be more respectful. So, I guess it comes down to the fact that they don't want to be bothered.
Is it different with the new docs starting up a practice? Do they appreciate getting the calls? Just wondering.
It's hard to generalize, and it sort of depends on the specialty. Surgeons fresh out of residency can either be brick walls repelling all admits and turfing as many consults as they can to other specialties (techniques they mastered during training) or they may be hungry for business and eagerly take on all cases to build their practice. Medical docs often accept admissions without argument during the first few months of their arrival to a new hospital, until they get beaten down by the endless onslaught of soft admissions and frequent abuse by other services. Then they often harden up too.
But exceptions are the rule, and it really depends on the individual, the time of day, and their current state of mind.
And that's why you never injure your hand during a ABPS/PSEF meeting....
You're lucky you have that many guys on call. Around here the plastics and ortho guys are all dropping ED call and going out to surgicenters.
I'm surprised it took that many calls. I could understand if it was an Acetabulum or Replant, but distal radius fractures are one of the most enjoyable cases in Orthopedics surgerywise. As long as they are neurointact and can be halfway lined up by the E.D. They can be splinted and seen in the office.
I probably wouldn't have made any calls about a distal radius fracture. I would have just reduced it and splinted it myself and sent him out. Although in order to ensure followup in an uninsured patient, I sometimes call the specialist on call to at least put their name on the chart.
This was more complicated.
I played musical floor beds the other night with a vomitting wheelchair-bound MR patient with a partial small bowel obstruction...
Called report three times, first time:
We're too busy, we can't accept that patient (after waiting 30 minutes to call report in the first place). Second time, oh, she vomitted (yes, but the last time was 6 hours ago), I don't want to take a vomitting patient (WTF? This is a hospital). Third time (delay of 30-45 minutes while looking for a new bed), new bed again, called the nurse, nurse was busy, called again, nurse was busy, demanded to speak with the charge nurse, and finally gave report. The patient had been in a holding pattern, admitted and ready, for 5 hours at that point+the 5 hours she'd already been in the department.
In other words...totally feel your pain. In our hospital, by contract, any floor RN can refuse any patient that they want. Most will take any patient and not bat an eyelash, but sometimes when a patient is MR or medically complicated, everyone will refuse.
And the whole time I bet the patient thought you weren't doing a damn thing for him and just chatting on the phone with your girlfriend/wife/broker/whatever....
You are lucky (or unlucky) to have all those specialist to call. At my 70k/yr hospital out here we have no Hand, no Plastics, no OMFS, no ENT.
And for this you have how many years of school?? I'm sure there was nothing else you needed to do in the meantime as well! Starry-eyed medical and nursing students, take note.
As a simple medblog addict, this patient ping-pong doesn't make me feel very good about my chances should I be unfortunate enough to sustain an injury and require treatment. Shouldn't apathetic doctors be, like, boiled in engine grease?
Lynn,
If you have insurance, you won't have this problem. Docs just don't want to get the EMTALA "freebie" patients who will take up time, complain, and never pay them.
If you have insurance, the docs would be all over you. Who can blame them, you wouldn't do your job for free, right? (and of course docs don't get paid more to work at night, though they should)
"Charge Nurse of the ER (I had to call her because she was in her office somewhere, not on the unit)"
NOT ON THE UNIT? Crazy talk, all of it! :O
Even the lowly greeter feels your pain to a small extent. I spent nearly an hour trying to hunt down the charge nurse because I had a direct admit show up and nobody (including admitting) knew where to put the guy. Eventually, I found her in some off-the-map store room doing god-knows-what. Maybe having sexors with the janitor.
Justin the specialists have no idea who has insurance or who doesn't. I've never had a specialist ask that question before.
Okay, now I was going to "wind down" by reading a few blogs and then going peacefully to bed---but now I'm going to be up laughing half the night over....Dr. Dikhed!
(You crack me up---so next time I'm going to read your blog in the morning when I need some laughter and cheering up!)
Lynn,
you should be worried some because Justin doesn't really know what he is talking about. EMTALA is taking specialists off the ER call panel completely no matter what insurance you have. Where I work we can still transfer you to the "teaching hospital" for ENT, Plastics, OMFS, Hand where you will be taken care of by an intern or second year resident.
Charity: While it may not be obvious to you, there IS in fact a logic behind the hot potato thing between specialists who deal in facial surgery.
If it involves the dentition, call the dental surgeons
If it involves the orbit, call the oculoplastic guy.
If it involves the nose of frontal sinus, call oto.
This is because when push comes to shove WHO will fix the complication?
Diplopia from a malunion of orbital bones? Oculoplastic will ultimately be called.
Malocclusion from a poorly treated mandible or maxilla fracture? Oral surgeon will ultimately be called upon to fix.
Bad outcome from malunion of nasal or frontal sinus bones? Who'll take care of the upper respiratory consequences? That's right- otolaryngology.
Bad scar form a less than "perfect" laceration repair? Who you gonna call in the long run? Yep- Plastics.
Soooooo....why not call the right people in to begin with?? At our hospital it took several rounds of meetings between admin, ER and the specialists in question to finally hammer out a sensible policy. Now there are no frustrated ED doc's or P.O.'d surgical specialists when that guy who "was minding my own business having a beer, when this dude...." comes in with a smashed face.
And Justin- it doesn't matter whether this guy has insurance or not. It's an issue of appropriate triage, not wallet biopsy.
Of course they usually end up geting admitted to medicine anyways like everything elso so why the big deal
I'm in an on-call position (not medical), and I've been burned-out beyond all recognition any number of times. I imagine it's much the same for docs. At some point survival instinct takes over and you become very protective of your time, your personal life and your sanity. No, you don't shirk your responsibility but there definitely are times I do NOT want to be called unless it really is my problem. What's the root cause? Not enough doctors! So we work the ones we have, around the clock. The flip side is good money. Can't have everything.
The flip side is good money?
I'd be willing to bet that most trauma patients are uninsured. But that won't stop them from seeking legal counsel if they perceive they've gotten a bad outcome. And it's amazing how the first words out of most face trauma patients is, "I'm gonna press charges!" or ""I' mgonna sue that motherf*cker who did this to me!!"
sorry you got caught up that turf war. that happened at one of our local hospitals so much that my department took over their trauma call. now the surgicenter guy "dump" all that uninsured crap on us. i say dump, because for some reason the insures simple fractures they do and the simple uninsured fractures they some how forget how to do. hmmm
perilunate dislocations have bad outcomes, hope it was his non-dominant hand
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