Home Forums Discussions General Discussion My Paperport Document

As I have had numerous requests for "my" fax management system using the Paperport software which comes with the Brother machines I am posting this response that I gave to another AC user. I am sorry but I cannot tell one how exactly the received fax folder was originally set up as my IT guy did that. Obviously the faxes come into the attached computer and from there, they are shared and (I presume) mapped to a network drive. From the server, this file is then accessible to all users.

The Brother machine is networked such that you can fax out from any networked computer or you can print from any networked computer. And, you can print from any networked computer to the Paperport software. You must download the Paperport software onto each machine. Then you can choose the Brother Fax, the Brother Printer or Paperport as printing options. When you choose the Brother fax and then click "print" the fax window comes up. I have it set to show the little fax machine doodad. You can go to settings, enter your info, choose to include or not include cover pages (I do not include a cover sheet except in special circumstances). If you choose to make a cover page on the fly, there is a little button on the fax machine window which you can click. You then enter the fax number to which you are sending and click "Send". There is also a program with the software called PC Fax Address book where you can store commonly used numbers, such as the local pharmacies and other docs. I fax scripts right from the room by completing them in AC and "printing" to the Brother fax. Works great.

But, to receive faxes, the Brother has to be connected via USB directly to one of your computers. Believe me, we have all had many discussions about this and why or why it is not so. I have not found a way around this although Bert seems to think there most certainly should be. For me this is not an issue as the machine sits up front next to the receptionist's PC and it is connected to hers.
I have a folder set up called "Received Faxes on Server 01" into which all the incoming faxes come. This folder is on my Server and is networked to all other computers from there.
Within this folder are the actual documents which have come in over the fax. They arrive in a .tff format. You may singly convert them to PDF format by right-clicking and choosing this as one of the options or you can choose "Select All" and right click and choose. This last feature will not work if any of the documents already on the desktop is in the PDF format. No one touches these documents but me. I do the converting, unstacking, deleting of cover sheets, naming, etc. I review each and every fax, mark them up as needed (such as "schedule additional views" or "Call patient and have them make follow up"...blah, blah, blah. I stamp them with my signature (I'll tell you how to set that up later) and then move them into the next appropriate folder. The following folders are then subfolders of this one. As such, they are viewable by everyone.

Named Staff Folders
Each staff member has their own named folder, e.g. "Ann's Folder, Lindsay's Folder, Theresa's Folder". All of these are the same folder color for easier locating. When you set up a new folder, you can pick the color. Into these folders go the marked up documents from above. Theresa does most of the billing so if it pertains to that, it goes into hers. Lindsay and Ann do the scheduling and calling and other crap I hate to be bothered with so their folders take in most of the documents. The staff checks their folders often, act on my instructions, mark up the document (such as write down the date and time of the CT or that the patient was notiofied of results or that the patient refused to make an appointment), add their initials and then move the document from their folder to "Physician to Sign Off or Ready to Import" depending on whether I need to know what was done. (I have very good staff so I trust their judgement in deciding this).

Physician to Sign Off
Into this folder go all documents staff have "marked up" using the Paperport tools which need my final signature or attention. It also receives all of the mail or unfaxed documents which are scanned in daily. It also is a storage place for me for documents I want to spend more time on later or things I personally need to deal with.

Ready To Import
This folder holds all the documents ready to be imported into AC. One can browse for this folder via the AC Import function. All staff members check this folder when they have a little free time and import just as they would file papers. All my staff have full sign off rights in AC so I do not have to mess with signing off a bunch of stuff again. But, I have strict rules that nothing goes into this folder unless I have seen it and signed it off. So, if a staffer notes my signature is missing, they put it back in "Physician to Sign Off". Works 99.9% of the time.

Refills
I have subfolders here with the current month and the previous month. Each month is again subfoldered into more manageable folders such as A-D, E-H, etc. When a refill request comes in, I mark it up in Paperport, stamp my signature, fax it back, name it and move it to the appropriate subfolder. If it is for a controlled drug I open AC and update it there also. If I want to check when I last saw the patient I will check in AC and perhaps tell the pharmacist to refill only # 30 and tell the patient they need an appointment. Then that refill request is moved to a staffer's folder so they can also call the patient and relay my message. They then move it to the appropriate month's subfolder. Each new month I delete the oldest month's worth of refill requests. I have found that keeping them is burdensome, bunglesome (yea, it's a word, I looked it up once) and mostly unnecessary. Most issues are dealt with in less than 60 days. If a mail order accuses me of not faxing back, I can pull up the refill request and tell them "I most certainly did...their fax must be busy too often. I will pass that info onto my patients".

Office Documents
This folder holds all the forms (lab request sheets, precert forms, ABN forms, my H&P forms, HIPPA forms, etc) and documents my staff needs. They can either duplicate it in Paperport, mark it up and fax to wherever it needs to go or they can print it out, complete it and hand it to the patient.

Photos
Into this folder I download the patient pictures we are in the process of aquiring. When I have time, I then adjust the size, name them and staff import them into AC.


Each of these above folders has it's own color for easier visual locating. As I mentioned, all the employees folders are the same color.

Now, once you have your incoming fax folder on your server (or network) go to each station and open Paperport. Click on "Tools", "Paperport Folders" then "Add". You then browse to your network and find your received faxes folder and add it. It will then show up on the Paperport desktop on the left under "My Paperport Documents". Make sure you have your "View" set to see the folders on the left.

To make your signature stamp, use a heavy marker and write your signature on a blank paper and scan it into some image modifying software. I cannot remember if I used Paint or Adobe. I had to play with the sizing options several times until I got it right. It has to be saved as a bitmap...I have tried saving in other modes but I do not think Paperport will allow others. Unfortunately, I have not figured out how to make the background transparent...might be able to do it but I have not yet succeeded. Store the signature somewhere (I "hid" it on the server in a folder where most staffers would not have access). Then open up a document and right click on the stamp icon on the left. It should ask you if you want to prompt for file and, if I remember right, should allow you to browse for the signature file and select it. After selecting it, the next time you use the stamp function, you can turn off the prompt for file function and it should remember which file to use. (I hope this is correct. It has been awhile since I set this up).

I think those are the basics. This has worked very well for me and it is a freebie...can't beat that!! The worst thing I suppose however is that the mark-ups made are not permanent. They can be removed while still in Paperport (right click on any change and you can delete). But, at this point it is probably as secure as paper.

Also of note, make sure your Received fax folder and subfolders are all included in your daily (or better multi-daily) back-ups. I have been unfortunate to have folders "disappear" for unknown reasons. This happened several times early on (actually I think it was my fault...I deleted when I meant to save). It has not happened now for a long time.

Also, every once in a while we all just get a feeling that faxes are not coming in like they should. This requires a rebooting of not only the fax machine but the computer to which it is connected. You will then see the Receiving Fax icon on the lower right of the toolbar begin to flash as faxes arrive.

If anyone would like a screen shot of my personal Paperport folders, PM me. I am too stupid to know how to put it on here.


Leslie
_________________________
L. Strouse, M.D.
Solo Internal Medicine
Southern Indiana

Thanks again, Leslie.

Leslie:

I use Paperport much like you- though with limited to zero staff depending on the week. Just this afternoon however, was considering workflow and when staff is present needed to have method to interface with folder from the primary computer attached to Brother by USB- have been importing from it to my workstation.. planned to check here to review this evening and what do I find but your wonderful full explanation that included the one piece I had missed- the ability to add a paperport folder from the network. THANK YOU!

I have had difficulties signing some tif files and then having the annotation end up lined up incorrectly- not sure what is happening. Now I duplicate as pdf then annotate- works perfectly.

I find myself feeling irritated if I have to print something on paper now!

Glad it helped, Carla. That took me a while to figure out also. But at $95/hour for IT time, I was highly motivated. And you are right. You cannot mark up a .tff file and save it without the mark-ups ending up where you do not want them.

Leslie

Nice work Leslie. I think I will make it sticky with EXTRA glue.

Leslie:
Great detailed post!!!! Thank you for sharing it.
One question though. Why not recieving the documents already in PDF format?

R.,

I wish I could answer that for you. The manual that comes with the machine is pretty limited and, truthfully, I have never researched on the CD if this can be changed in the settings or if the .tff is the default. If someone knows how to change this I would like to know too.

Leslie

Do we really have to have all faxes converted into .PDF?? What are the reasons, if any? Is there a concern about imported files in different file formats?

I like to beleive that we can save those in any format (i.e. .tiff, .jpeg, etc.) and import it in AC. AC imports all the letters created within in .html format?

Please share your thoughts..

You can have multiple formats, but it is easier on the system if there are limited formats, pdf and html for example. Otherwise you have to keep opening different "reading" systems to display the documents.

PDF may be more compact than some but this depends on the type of document.

Also, if you make any mark-ups to the document while it is in .tff and then save it, those mark-ups somehow migrate from where you put them to some other location. Frequently, the markups cover up the text of the document. Converting first to pdf eliminates this.

Leslie

Health Obama:

There are multiple, multiple reasons to use PDF. It's very name is Portable Document File. It is the most widely used file for attachments, transferring and documentation in the world. Everyone has an Acrobat reader and, if not, you can find one anywhere. Not everyone has a TIFF reader. You can do sooooo much more with a PDF document.

I am not sure why you would want any type of document to be saved to JPG.

Word is find, but it is too easy to edit and takes five times longer to open than a pdf. PDFs are much easier to merge, etc. It is also more difficult to change a pdf, although it can be done. And, as stated PDFs can be marked up in many, many ways.

This is only my opinion, but I wouldn't use anything other than PDF to save documents. It is, by far, the best -- again in my opinion.

And, depending on what program you use (there are many, many 3rd party apps that work with PDFs) -- I still use Adobe itself, you can do unlimited things. With TIFF and other formats you can't always choose from one click email, combine, collaborate and even upload to Share.Acrobat Online. With Adobe Extended (pricey but incredible) the documents and presentations are incredible. With Adobe Connect Now Beta, you can have online meetings that rival and are even better than WebEx.

Convinced yet? I could go on and on....

I don't use Paperport, but I helped a fellow ACer set hers up, and you can definitely import in PDF. I don't know if I can recall the exact steps.

It can also be networked, but I am not going there, because this is Leslie's thread, and I am not about to hijack it. It is just too good of a thread!

Bert, You are absolutely right and I am already convinced with .pdf format.
My reason for asking is because I am trying to decide about a fax software that can shorten the workflow process from Receive to SEND and for most part can minimize Doctor's time and clicks on the received fax file. In doing that,

I am trying WINFAX which saves the file in it's own file format which later can be converted into .pdf, etc. etc. But Winfax file editor is not great for Annotation. So Doctor has to open the file in Acrobat and add comments and signatures there. However, the good thing is that we can easily write .pdf files to Winfax printer when we are ready to send a fax.

On the other hand, I am also trying Snappyfax that is really a good program with a lot of features and it is very easy to setup in a network, if required. SF has a very good file view/editor. The best thing about it is the BURN feature that permanently saves the annotatation and the signature image. The annotated file can be saved in it's own database in addition to outside of Snappyfax. The other option I like that you can save the files in .pdf automatically when received in your specified folder.

However, the bad thing is that you cannot directly send or drag/drop a .pdf file into Snappyfax. It restricts you to .tiff, jpeg, etc. and that is where I stop and think about other options available. You can print a .pdf file to snappyfax printer once you open the file in Acrobat, but you lose the quality a little in this process..that I don't like...

Annotations(markups, comments, signatures, etc. etc.), as you know in Acrobat can be inserted but I haven't figure out it to make it permanent (burn it). Is there such feature in Acrobat? I use Acrobat Statndard 8 fo all of this.

Marking up and keeping PDF markups permanent has always been a difficult process. PDFs are designed to be made as originals and then remain. This is why PDFs have all of the signature features, etc. which you can make to sign documents and call it secure from that point. (I meant the actual security signatures, not the stamps). There are even stories where the CIA and NSA have made redactions and then people would print them, and the words were still there. Not good.

Here is one way, although it is an extra step. And, you can't do it with sticky notes. They are just what they say: sticky. And, they can be unstuck.

But, if you use the red outliners or typewriter to mark things up or the highlighters and underliners and THEN print that document to PDF, the changes are there forever. They are now part of the document.

Bert,

If you can help us figure out how to have the faxes come into the Brother MFC in PDF formats and how to receive faxes to PC without USB connections, please chime it. I may have Paperport down pretty well but I certainly am no pro setting up fax machines or networks.

Leslie

OK, I will. Let me talk to Tish and see if I can go by her office and look at her setup that I helped with. It's easier hands on.

Don't go without bearing gifts. A lobster and a six-pack of Heiniken sound appropriate.

Leslie

If you knew Tish, it would be the other way around. I will have to get her to come on here. She is an AC convert and bought the Brother on my advice. More in PM.

Great post Leslie.

Myself, I am an IT guy/engineer/go to guy blah-blah. Far more importantly, I have some experience with the 7440 series of Brother MFC's.
A couple of things:
The 7440n is a ethernet capable version of the thing. Even if you own it, I don't recommend using it, as it doesn't seem to play well with routers, and having a computer play print server seems to be the best way to set everything up for dependability. That said, you install the Paperport/Brother control center suite on several computers on the network, but it will be plugged into a single computer by a USB cable. The printer and the PC-FAx are set as shared printers.
With Paperport set up on all computers, setting the paperport B/W (older version) or Paperport print-to-PDF as a default printer on all the computers can now be a handy thing.
In use: With the Brother Control Center 2.0 up and running on the print server computer, you use the different settings there to change the format that faxes and scanned items appear in Paperport. For instance, you can set up the scan button on the machine to always print to a black and white PDF (or MAX, or TIFF, or JPG, or whatever). You can then, as a standard alternative choice, make the "scan" software button in the Brother Control Center 2.0 always print to Paperport as a 24 bit color jpg. This is fine for most instances, since you can then scan in patient's horrible paper document thingies into Adobe images with little thought involved, and then use the Brother control center button to scan a color image of the patients ID and insurance cards. There is another place to work (actually many other ways to do this) the scanner. My favorite is in Paperport itself. I hit the scan button, make the choices that I want in that particular instance (type of file, resolution of file, and size of the scanned document and then hit scan right there. This way, if you want a large collection of documents scanned and stacked together, you can do so. When you want to start a new stack, you close the scan utility in PP and start it again.

The same can be done for PCFAX. Use the Brother Control Center to manage these settings. Unfortunatly, there is no documentation included with these machines that covers the PC fax function, but there is a PDF that can be found in the help links in Brother Control Center that can get you to it. It is poo, but don't be scared to experiment with it a bit. I:n the case of PC fax, you don't want to even try to go looking for a menu to control stuff on the machine itself...It doesn't exist.

Remember, that when you create a PDF with this program, the PDF is still just an image. It is difficult to clean them up or edit them. If you really need to capture text from them, look at that little notepad icon on the bottom of the screen in Paperport. That is the OCR printer...in short something that will take a scanned image and turn it into a text document. This can be very helpful to grab PMI etc... for cut and pasting (and of course editing after verifying the data). Learning to digitally sign imported documents (helpful with things like event/holter monitor reports and the like) with Adobe is nice, but be aware that Paperport, and even MS Paint can allow you to do this as well.
In closing: A well rounded suite of office software that nicely compliments AC is OpenOffice.org . This will give you far more dependable document handling and power than MS Office, and (despite what some say) even works very well with Dragon and other programs if you make some custom user settings.

Personally, I would rather have nothing but HP printers in my office. That said, there seems to be no other choice for PCFAX in a laser printer. If I REALLY had my druthers, I would not have a printer in the office at all, and only a modem with PC fax for receiving faxes from those hopelessly lost individuals that seem to think that HiPPA says that they can fax stuff but not e-mail it. That is, of course, total squat. Not only can you e-mail it, but technically you do not even have to encrypt the files that you send. Fax has a fraction of the security that e-mail has (I am really talking about when you run your own server with hmail or the like running on it, not when your office has a "Yahoo" account). What is more, you can use password protected documents in either pDF, or Open office format and send them anywhere.
Other free software that is really nice to use in electronic transmission that far and away satisfy the "reasonable measures" of security that HiPPA requires:
PeaZIP. Allows you to package files into a zip file and then password protect them with 128 bit encryption.
TrueCrypt: Software that allows you to make secure "containers" for files, virtual drives, and even hidden operating systems. This is a MUST for anyone transporting data on a laptop or or on a thumb drive. This program can not only hide a pack of files on the computer, it can hide the whole hard drive. The department of defense could not prove with any certainty that you even have any data on your computer with it protected this way ("plausible deniability"). It's nice to know that if you dropped a thumb drive out in the parking lot with your bosses' mother's medical record on it, it would be totally unreadable to outside persons. Likewise, if your network got hacked, and everything got horked off your server, the data would be just a bunch of random noise. Of course, if they can figure out exactly what 1000 digit prime numbers were factored then used to encrypt the data, they might be able to figure it out, but only if they have a few years of supercomputer time, a lot of luck, and knowledge that the files are there in the first place.

Aethelwullfe,

OK, I definitely have to give it to you. You, definitely are the Brother MFP Paperport guru. Wow, with Leslie's and your post, there should be no one on here who can't do PC to Fax, Fax to PC with PDF. I knew I had faxed to PC once with it, but I think I just fell into it. And, I have to apologize to Leslie, it does seem that using a computer as a print server using USB is the way to go with Brother. I do have to have an issue with Brother for making network MFPs that don't network well.

The tips on making PDFs with Optical Character Recognition is perfect. Thanks as well on the emails tips. I feel the same way. Although, the issue is never on THIS side, it is always on the consultant's side, when they can't even enter the password you sent. And, I generally send the password under separate cover, which really confuses them. I suppose I could fax the password with instructions as to how to open their email and open the PDF. Of course, some doctors even refuse to give out their email addresses as if they would rather receive SPAM than friendly referral emails. But, I digress.

That was an excellent post. I am certainly good with my Xerox and Captaris fax server just as many on here like Snappy Fax, but when it comes to just the basic PC faxing and certainly the Brother, you are the man.

If possible, if you could change your user name to an actual first name or put it into an auto signature, that would be great as I am sure many will want to talk to you.

Whew!!! That will take me a while to digest but I am relieved that I will no longer have to bear the misnomer "Paperport Expert".

Once I can find a few extra minutes I plan on tryng out your suggestions. Too busy right now trying to keep my cool with Anthem nd Humana who think my skills warrant no better reimbursement than the cost of a 40 lb bag of cheap dog food.

Leslie

No, you will always be THE Paperport Expert. He is just the guru.

With both of your posts combined, it is pure ecstacy!

Hey great paperport thread! Another AC user pointed me here.
I've been using paperport similarly, but I have a couple of more tips for use which I learned from the school of hard knocks:
1) if your annotated stuff moves around in tiff, it is because you need to first SAVE the item with the scroll bar at the top of the document and way to the left i.e. showing the upper most left hand most corner of the document in the viewer, then the annotations will save to the right spots.
2) for signatures, all I did (and this is the work of a simple mind) was scan in a piece of paper with a bunch of different sized signatures on it. It sits in the main work compartment, my receive to PC to folder, and when I need a signature, I open viewer to the paper with the signatures, use the box on tool box right hand or upper menu bar to copy the signature, then go back to the paper that needs the signature, ctrl V to paste then move it to where I need it on the thing to be signed.
be sure to 'sign it' and then scroll back to upper left hand corner at the the upper left hand side of the paper

Lynn

Ethel Wulfe,

OK, I must not be doing something right. I followed your instructions and was able to set the scanning preferences in the Brother Control Center panel (actually, I had already done that). However, I still cannot configure the preferences for receiving faxes into the "print server" computer. There are options for faxing out but none for faxing in....at least none that are evident to me. Could you take me step by step in how to select PDF as the preferred received fax format?

Thanks,

Leslie

Ok, I'm back again... one more question re: document handling.
I do have a Brother PC-Fax setup and thanks to Bert, Leslie and a few others, I have set it up can use it and can bitmap sign. That is a big deal... for a non-tech person.

Question. I receive faxes from my hospital with multiple different patient results... could be Ms. Jones mammogram, Mr. Smith's lab, Mrs. Wilson's colonoscopy report all in the same single fax transmission. I know that in paperport you can unstack the documents. Can I make them each a separate file at some point such that it would eventually be easier to import into AC under the patients name....

I tried to manipulate the unstack command but didn't find a way to create a new file for each patient before distributing to the staff to process. Comments would be helpful. Remember the KISS principle please.... I have way to many computer terms in my head but nothing to really assimilate them to, so for point of discussion, assume I am clueless.... you have my permission. LOL

Thanks in advance

Well, I can't speak for Paperport, although I am sure you can do just about anything with it.

With Adobe, you just open the document you were referring to, and then you set it where all of the pages are also in thumbnail view on the left. You can then drag and drop any of the thumbnails on the desktop, and they become separate PDFs. So, if the first three pages were Mr. Smith's, you just use the control key and click on each one and drag them out, and they are now one PDF.

I wish they didn't send them all together. At least we were able to negotiate with our lab, and they at least send a cover sheet with the names on them. We are the only ones they do this for. Pretty cool. All of our radiology faxes come separately.

Jen,

Just as Bert suggested.... single click on the combined document, got to "Item" on your desktop toolbar, click "Unstack" then "All pages". This will then unstack the whole pile. Then I go to "Arrange" also on the toolbar and click "by date". That generally puts the documents in the correct order. You can then drag and drop documents upon each other making separate multi-paged documents, each containing on patient's papers. Name it and import to AC.

Leslie

Leslie and Bert,

As always thanks for the helpful tips. Leslie, on average, how long does it take you to process your incoming data each day?
I know there is a learning curve here... just wanted to get an
idea of eventually what to expect timewise.

I would guess a few hours, definitely longer than it did with paper because I am doing more of the stuff that my staff used to do. For instance, I complete and fax back all the refill requests, I convert and name all the incoming faxes and put them in the appropriate "boxes" and I update AC when needed. My staff would have done these kinds of tasks previously. I log in from home most nights and finish waht I did not have time to do during the day. So there are some definite disadvantages.

Leslie

I agree. Happens to me, although with my program, they do all of the naming. But...this gives the staff more time to go out and get Iced Coffee even if they do use my card, lol.

April 21 is Iced Coffee Day AND the end of RSV epidemic in Maine!

WARNING: The following link can cause huge cravings for caffeine.

https://www.dunkindonuts.com/icedcoffeeday/

We used to get a Mickey D's iced coffee at least 2-3 times a week (easy to do as my office is right next door). But then they started using a machine with a fixed recipe and now they are terrible. So, we are experimenting with our own homemade concoctions. After the second or third one each day you really don't notice the other people bouncing off the wall as they fly past you!

Leslie (aka Marty Feldman sans LATS)

Well, I just fired four patients. That made me feel almost as good.

Bert and Leslie,

I decided to put an expresso maker in the office for just that little pick me up during the day.... you are right,Leslie when you don't notice them when they fly by you.

I have an older population.... imagine pitbulls with gray hair and walkers.... they are tenacious and rude to the staff. Just fired 3 of them this week for insulting the staff(cursing).
The best is that because this is an underserverd area medically,
some of these folks have never experienced being denied acceptance into a practice because I don't par with the insurance...... Because I am on the fringes of appalachia I might consider a metal detector as the next addition to my offic.

Ok, now all griping aside, Leslie, is it really a good use of your time to do most of the sorting... renaming yes, editing yes,
but faxxing to pharmacies.... can't that be done by someone else?

I have found, that I will need to be the one to sort and name... as the hospital sends bulk faxes of multiple patients documets..
And, they like to send them multiple time.... I can' wait to see what I save on paper and toner this year alone....

Last question, Leslie, did you load your bitmap signature on each pc you use? I created it when playing with the files on the server.... but it is not stored there. Now, when I want to work off a laptop in the room, I can't access the file....
I know this should be easy..... I take it that when you work from home you remote access your system? I can do that in the office as opposed to reloading/finding bitmap files on alternate pc.

Jennifer,

Yes, it would be nice if the staff could do the faxing back of scripts, which they certainly are qualified to do. But, as long as I have the document already open, it just seems easier for me to go ahead and send it. And that then gives them more time to call patients with results, confirm appointments, and import documents into AC.

My bitmap signature is "hidden" on the server. The first time I "prompted for signature" on each computer, it let me browse and find the signature. Now I do not have to prompt for the file...it is chosen automatically.

As far as rude patients, I simply will not tolerate them either. And, if I have had too many iced coffees like I did today I won't tolerate rude specialists either. I know this is off-topic but I just sent a "pitbull" letter to one whose faxed request for information on a patient I referred included the statement "All records and patient demographics must be received from you prior to the patient's appointment. If these are not received, the patient will not be seen. All records will also be reviewed by the doctor prior to the visit and the appropriateness of the referral will be determined at that time. If it is deemed the referral is not appropriate the appointment will be cancelled. Also, patients who fail to show for their appointment will be charged a $100 No Show Fee". Well, I was livid. He has seen his last patient of mine. Think I'll go home and throw some Amaretta in the coffee and see if I can calm down!!

Leslie

Damn, gotta love Jennifer and Leslie. I have had a problem lately with patients' leaving. It has been frustrating, but I have decided to fight back. Like Leslie, I am no longer taking rude crap from patients. It will take very little to fire them. The mother of the four above called my office to tell me she was taking her kid to the ED, because "she doesn't like me or my office." Uh...OK. So, I sent her a letter. So today she has the gall to call my office and ask what the result of the RSV test was. So my nurse told her even though I would have told her to call the ED. Then she tells the nurse that I like you, but I don't like anyone else there. So, I sent her another letter telling her to ask her new doctor what her results are.

And, consultants. Holy cow! I sent a patient to our local peds surgeon. She thought the left sided pain was due to scoliosis so she referred MY patient to the orthopedist without even telling me. I shouldn't be surprised -- consultants do this all the time. So the orthopedic surgeon sees her and says it is pulmonary, sends a note back to the surgeon and does not copy me recommending pulmonary to look at this pain on the left side. I finally called the mom and stopped all this. She goes to see Dr. Lauer tomorrow.

But, I know what you mean, Leslie. Nothing is more frustrating than a consultant asking for records to decide if the consult is necessary. The consult is necessary, because I think the patient needs the consult. Period.

Amen, Bert.

I have much more sympathy for rude patients than rude consultants, however. If you could be a fly on the wall in their lives, you might see why they are rude. Not that we should be taking all their crap but maybe that's why they pay us the BIG BUCKS. With all respect, you guys sound like you need a vacation. I just got back from one and I am finding myself much more tolerant for the time being. As for the rude consultants, they should see a gastroenterologist. They might be able to tell them what to do with our records and necessary consults.

Well, as I get older I am definitely less tolerant. And, I am so tired of being considered a second-class physician, merely an "accessory" in the care of my patients. Specialists by-pass me all the time. I retaliate by then by-passing them. Gone are the days of keeping my mouth shut and simply letting them walk all over me. I will very eagerly explain to a patient why I prefer to refer to one specialist over another. One of the oncologists in town now regularly refers patients on to other specialists, without even calling me to discuss it or to find out if this has already been done. He now no longer sees new referrals of mine. But, this is a whole other topic and I could go on and on. I will leave it at this. Primary care is at a crossroad. We are at war. Not only with insurance companies but with many of our specialist "comrades". If we do not come out of the trenches and begin firing back we will dessimated. I can no longer sit back and watch the grenades hit all around me and wonder if I will be next. I have to pick them up and throw them back. I graduated second in my medical school class. I am not a stupid idiot internist. I chose Primary Care as my "specialty". I did not end up here by default.

Leslie, who is heading to the coffee pot

I have tolerated both rude patients and specialists, but few of the latter.

I have always given quick feedback to specialists when I think their behavior is inappropriate. In one case, it helped and he apologized. Most of the time I never find the results, because I will find another specialist, when I can.

With a large population of public aid, specialist options, even in medical mecca like Chicago can be daunting.

I do consider the source, but am quite willing to jetison patients who I feel are unnecessarily rude and may be a malpractice risk. Unhappy patients are more likely to sue, why give them a chance.

I agree. I, by the way, graduated first ahead of Leslie. Totally kidding, she is much younger than I.

There are certain reasons why we think the way we do. I think it is difficult for a specialist to not think, "Well they need us and we do not need them." That would be true in a competitive market, but I cannot afford to alienate some specialists. I have written many letters that never got sent.

I did send a letter to one specialist who kept telling the mother of my patient that she would do this or that to his meds that she wasn't managing leading to the mother always telling me that. That was frustrating.

One good thing about specialists is when I get told by my staff that he or she is on the phone, I can get coffee before I answer it. I used to run out thinking I was keeping the almighty specialist from his or her patients, but then I realized it was his receptionist waiting. The ED does the same thing.

Well, Bert, that is an excellent idea about getting coffee!!! However, my policy has been that my staff tells their staff that Dr. Strouse will not come out of the room until their doctor is on the phone. If anyone has to hold, it will be them, not me.

Leslie, going for more coffee