Bert, I suppose you knew that I would weigh in here. Where to begin? Certainly not by trying to defend our "colleague" whose behavior is terrible on multiple counts. We (meaning all gastroenterologists) are trained to manage inflammatory bowel disease, and while there are certainly cases that are too sick to handle, it sounds like this guy is looking for excuses. The patient is ill enough to require care, but not emergency admission or even an emergency visit... in fact, it sounds like you already know he needs Remicade or some other biologic agent. So this GI should be able to help you and the patient and handle that. If not, he should offer you more than "send him to Portland".
Larry, while it is true that some "GI docs are interested in procedures not management", that really is not true for all of us...I can see why someone like this would encourage that stereotype though.
The only other reason I could see for him to refuse the patient is that he had already left the practice. Many people have a policy against taking someone back. But again, even if he is unwilling to help the patient, he should at least be helpful and polite to you, his colleague.
This type of story never ceases to amaze me. Partly because I feel like Mel and Larry that we are "in this together" and should support each other. In addition, I am in an area where many specialists are tripping over each other. Our livelihood depends on providing good care and good service; we rely on referring physicians. Whenever I hear a story of a rude or unhelpful specialist, I always tell the primary care provider, "just don't ever send them another patient; in fact, spread the word to your friends about how you were treated". I am sure things are different when you don't have many choices... Maybe it is time for me to move.
Bert, contact me if you want to discuss management of this patient.
