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:Â ‘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:Â ‘Well, the hospitalist will get paid for seeing him, not you!’
Him:Â ‘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.
As a family physician who recently stopped providing inpatient care, and started using a hospitalist I have seen both sides of the “admit your own vs. use the hospitalist” scenerio. From a what’s the best patient care it is close. I do think the hospitalist has advantages I cannot match for care in the hospital, 24 hour in house availability, much more current experience with the day to day workings of the hospital, etc. The problems stem from the difficulty of getting timely coordination of care info to the primary physician. I routinely see the patient in follow-up before a… Read more »
Dr. Pullen, I agree with the need for more primary care! My point is this: if we have more primary care, that primary care has to be accessible. And by that, I mean evening hours, weekend hours, etc. We in the ED are always accused of being the most expensive care. Whether that’s true or not, patients seek care when they need it. And many of the patients I see have called their primary care doc, who was too busy, too late in the day or offered them appointments next week. Then, there’s the ‘I think you may need some… Read more »
Justin
13 years ago
I hate the daily battle for the unassigned patients at my facility. The hospitalists want to do as little as possible as they say they don’t get an incentive per admission. The residents of course make the same if they admit 0 or 30. So you call the resident service, and they say that back in 1993 the patient went to doctor so and so, and the hospitalist admits for them. The patient states he fired that doctor in 1994. The hospitalist then states they don’t admit that patient because he goes back to unassigned. Then unassigned is capped. Then… Read more »
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This is one of the reasons we needed “7 ways to stay calm in the ED” for Grand Rounds!
As a family physician who recently stopped providing inpatient care, and started using a hospitalist I have seen both sides of the “admit your own vs. use the hospitalist” scenerio. From a what’s the best patient care it is close. I do think the hospitalist has advantages I cannot match for care in the hospital, 24 hour in house availability, much more current experience with the day to day workings of the hospital, etc. The problems stem from the difficulty of getting timely coordination of care info to the primary physician. I routinely see the patient in follow-up before a… Read more »
Dr. Pullen, I agree with the need for more primary care! My point is this: if we have more primary care, that primary care has to be accessible. And by that, I mean evening hours, weekend hours, etc. We in the ED are always accused of being the most expensive care. Whether that’s true or not, patients seek care when they need it. And many of the patients I see have called their primary care doc, who was too busy, too late in the day or offered them appointments next week. Then, there’s the ‘I think you may need some… Read more »
I hate the daily battle for the unassigned patients at my facility. The hospitalists want to do as little as possible as they say they don’t get an incentive per admission. The residents of course make the same if they admit 0 or 30. So you call the resident service, and they say that back in 1993 the patient went to doctor so and so, and the hospitalist admits for them. The patient states he fired that doctor in 1994. The hospitalist then states they don’t admit that patient because he goes back to unassigned. Then unassigned is capped. Then… Read more »