Good topic. Wish everyone could all get together and talk about this. I never see these anymore, but in medical school (maybe it was Vermont) the consultants would always do an APSO instead of a SOAP note. I think Larry Weed got it a bit wrong or maybe there needs to be another Weed for specialists. At first when I read them, I was questioning my medical school faculty, but it made sense:
Assessment: Cholecystitis
Plan: Remove gall bladder
Then all of the the patient presents with two weeks of RUQ pain and vomiting after drinking chocolate milkshakes at Dairy Queen, etc.
We get these 30 page neuropsyche reports on our patients. 15 pages of it are the testing results of the Woodcock Johnson, etc. I just scroll down to the Diagnoses of: Mood Disorder, NOS, the rule out this and rule out that. Of course, here it takes literally seven months to get this consult probably due to the report taking four of those months.
On the same subject, one of my pet peeves is, "I saw your adorable little 3 year old... "I saw your patient is fine." And, then the consultant always ends with, "It was a pleasure taking part in the care of your patient." I know my patients, and I know that it would be a pleasure with around 30% of them, but the others are anything but pleasurable to be around.
Then there is the anesthesiologist who calls me for instructions on how to manage the patient with adrenal insufficiency. It's basically, give tons of steroids before the surgery, give tons of steroids during the surgery, then give tons of steroids after the surgery.
I could be wrong here, but I don't know how many of my patients have had surgeries for ear tubes cancelled due to a cold. I mean you can intubate the child. I doubt a Rhinovirus is going get by an ETT. I don't know, maybe they are at higher risk. And, it is elective.
I also love it when my patient sees a consultant, and they do a great job with the consult, but then they tell them they have this disease or should be on this medication and now the patient comes back demanding these things.
Finally, it would be great if all of the doctors and pharmacists, etc. could meet in one big area and decide which of two islands they want to work on.
The ones who want to answer phone calls as they come in so we don't both play phone tag would go to the Efficient Island. The same island would be home to consultants who give a consult date at the time of the call. I don't care if the consult is a year away, I just want to tell the patient February 15 at 2 pm. Half of the people we refer to (these are usually developmental psychology groups) always say, "We will call the patient, and they call them two weeks later," and we never get told when the appointment is.
For the pharmacists who want to be on our beautiful efficient island, they have to actually say to the patient, "Oh, I never got that script -- maybe ePrescribe didn't work -- let me call your doctor." Or, "ou are self pay, and Dr. so and so prescribed Vigamox. That will be $85. Let me call your doctor and see if he or she will prescribe Polytrim drops." Instead, the patient call me from a cell phone, and I have to call back the pharmacist, etc. etc. because the pharmacist can't actually take the cell phone from the patient. Or, for some reason, patients like to drive all the way back home before calling me.
Wow, I didn't mean to go into all that. Not really a rant, just some points that I wonder how others deal with them and to get the consultant's viewpoint. I am sure the pharmacist is thinking, OK, this is the 30th patient today who has come in claiming there should be a script waiting. I could see how it would be hard for them to call every time.
This won't make sense to those who haven't been keeping up with the other thread about the iPhone 4 vs HTC Evo YouTube video. But, I couldn't help but think about the consultant's receptionist telling us that the consult date will be February 15, 2011, and we would say, "I don't care." But, that is over seven months away! "I don't care." Your patient's appendix could explode. "I don't care."
Just in case you didn't see that thread:
http://www.youtube.com/watch?v=MvA8Hdmit-UIt's rated X for vulgar language.
