OK, since it didn't take off as planned, I will ask my question of the specialist of which Jon seems the most logical. This is not too much of a complaint, more as how does the specialist prefer this to happen and how much does the specialist consider the PCP to be a pain in the [censored].
So, this issue has come up twice. Once a week into practice and once three weeks ago. That is a span of 17 years. Both times the specialist became very upset with me on the phone and, given how loud he was and the fact that I didn't say anything for over a minute, my staff knew and it was embarrassing. So, this is about the telephone consult. Now, as stated, nearly 99% of these are successful, but I do know that some specialists aren't extremely fond of it. Plus, depending on the doctor and the specialty, they are done differently.
Many times I will have a patient in the room and a recommendation from the specialist will be extremely helpful. Of course, that means the specialist (can we make S mean specialist?) has to stop what she is doing just to accommodate you. But, just to state it, that is the ultimate help. Now the problem that came up and may be there but not vocalized is the S doesn't like being liable for giving advice about a patient she hasn't seen. It is this premise I strongly disagree with. In my view, it is partly how you say it that makes a difference. I think if the S says to you, "For your patient, I would obtain a urine micro via cath and a CBC and if they come back between these values, I would observe." Or she could say, "When I have a patient like that, I tend to obtain a cathed urine...." I know they are the same, but the latter seems to impose less liability.
Another thing I have observed is the following: When I call a S, many times it may take hours to days to get a reply. It feels as if the S thinks her time is more important than mine. That I need her more that she needs me. AND THE KEY THING IS...I can understand that. I think it is untrue, but I don't see how a specialist can't think that I need them more than the other way around, therefore, they may not be as quick to get back to me. I have often said to my staff a consultant more call me in four hours or 24 hours (almost always using a secretary to buffer the call), but they must know, that when they call me, they will have me on the phone within 30 seconds. I suppose part of this is the immediacy of the event. A phone consultation may happen within hours whereas a consult could be weeks away. Even so, the S would not have patients if the PCPs didn't refer to them.
I just feel it is extremely important for the PCPs and the specialists to work together. Many times I am just calling to see if the patient needs to be seen sooner than later by her. In defense, the S who went off on me on the phone is a pulmonologist, probably the S who would be giving me advice on the sickest patient. It's not like a dermatologist needs to be too worried when they advice you to use Triamcinolone 0.1%. He did tell me I consulted him more than any other pediatrician. I emailed him back a lesson in statistics. There has to be two ends of the curve. The doctor who has never called him. And, the one who has called him the most. That doesn't make me a bad doctor. And, he told me to use the local pulmonologist. I told him I preferred using him.
As stated, I hope this didn't come across as complaining. I would just like to hear what other PCP's experiences are and what the specialists think. Do they mind the phone consultation. Do they get extremely annoyed when the PCP asks if she can get out of a room. It is nice when the MA can ask if you want to wait or get her out of the room. 90% of the time, I tell them I can wait. Of course, sometimes it is seven days, and I can't even remember why I called, a good reason to write it down.
