Last night I had a patient with a bowel obstruction and abdominal pain.  He was sent for an outpatient x-ray, and subsequently to the ER, from the office of a gastroenterologist, who had recently performed both upper and lower endoscopy on the patient.  The GI doc, new to the area, doesn’t admit.  (I never really understood the rationale for that, but anyway…) He told me he didn’t know the procedure for admissions, or who the patient’s primary care doctor was.  Fair enough.

The patient informed me that he had been accepted into the practice of one of the local FP’s.  The paperwork was complete; all he needed was a first appointment.  Easy enough, right?

Well, the doctor who would be his primary was actually on call.  I contacted him.

Me:  ‘This patient has paperwork in place to see you.  Do you want to admit him?’

Him:  ‘No, if I haven’t laid eyes on him, he isn’t mine yet.  Better admit him to the hospitalist.’

Me:  ‘But, he’ll be yours when he is discharged.’

Him:  ‘Right.  But I haven’t seen him.’

(Apparently the ER has a problem with invisibility).

Me:  ‘Well, the hospitalist will get paid for seeing him, not you!’

Him:  ‘Yep, that’s fine.’

End of bizarre conversation.

The hospitalist admitted the patient.

Caveat:  the primary care doctor is now in a practice owned by the hospital (as is the hospitalist).  And apparently, the primary care doctor isn’t interested in incentives for caring for more patients.  So this isn’t an overhead issue, where he’d rather avoid the hospital.  He just wanted, as far as I can see, to avoid seeing the patient.  Never mind the excellent continuity it would have provided.  Never mind that he was not a difficult patient, an annoying patient or a soft admission.

Primary care will solve all our woes?  Not at this rate, it won’t.

Edwin

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