Tuesday, May 11, 2010

Being Oncall

It's been a crazy call. In fact yesterday might have been one of the worst calls I've had since I came on staff. True, you're thinking, "he's a consultant in endocrinology, how bad can it be??" and while it's nothing like internship, it was crazy nonetheless. I had a total of 8 new consults and 14 old patients to see, in 5 different hospitals (19 km apart). So I'm going to vent:
Some of those consults really pissed me off. And this is where I think I'm not as smart and as business savvy as my colleagues. Some of them feel that a consult is business, we shouldn't turn things away. Unfortunately I'm dumb; my thoughts are, if you really need my help I'd be happy to see your patient, but think before you order a consult if this is really necessary.
Case in mind, a surgeon who did a minor knee procedure on a patient with well-controlled diabetes on oral agents only, who just had to ask me to see him because he wasn't bothered enough to just write for this patient's pre-admission medications. In fact, I fumed when I drove 19 km to that hospital to find that he didn't even have any glucose checks ordered. When I asked for one, it came back 115 mg/dL- pretty damn good for a post-op. We've also had problems from a notorious surgeon who'd ask for consults for 'hypocalcemia' following thyroid surgery, only to find he hadn't as much as even ordered a calcium. Most of the time, we'd order it and it comes back normal. We sign off immediately. In the meantime, I've driven miles to see the patient. I skimmed through his medical records and usually review his thyroid ultrasound to find out why the patient had surgery in the first place. I'd examine the patient. And so, this brings the consult to a Level 5- the patient's hospitalization gets tacked with an additional sum from my consultation that was not necessary in the first place (no, that money doesn't come into my pocket, but goes to the clinic). Just because a doctor was too lazy to order the test before he ordered the consult.
Like I said, I'm pretty money-stupid and I don't think like some of my colleagues, but really, I could do less with these unnecessary consults.
(and I don't mean to generalize that all surgeons put in dumb consults as I'm sure many of you don't. Just that the same few here keep doing it)
I'm ready to hand off my pager tomorrow and break out that bottle of rum!