Specialists gotta get it right

I am not a gatekeeper. As an internist I’m expected to know a lot about everything, and I try. Part of that knowledge is knowing when a patient needs a specialist. Most people don’t like thinking their disease is so bad that their doctor can’t handle it, so I really count on specialists to care for my patients well. Following are the pet peeves, or really, the basic things specialists need to do to be real physicians worthy of the respect of their colleagues and patients.

First hint: neither of us looks good when the patient doesn’t know what’s going on. Let me explain how this is supposed to work. I send you a patient with a problem. You may or may not have all the information you need, but it’s OK because you’re a doctor and you’ve at least seen this in a movie or something. You have to take a history from the patient, examine them and form an assessment. After that, you need to communicate your ideas to the patient in a way they understand and write me a damned letter, or at least give me a call.

When the patient asks what I think about your opinion and I tell them I don’t have anything from you, it’s not me who looks bad, and it’s not you or me who suffers. And no matter how good you think you are, I’m not likely to ask your opinion again, since you didn’t bother giving it to me.

While we’re on it, don’t refer the patient to a new internist as part of their pre- or post-operative care. I’ve known them for a long time and they trust me, and now I was foolish enough to trust you. If I send you a patient, and they don’t ask for a new doctor, have the courtesy to me and the patient to keep me on board.

If I send a patient to you for an opinion it’s because I’m not sure what to do. Don’t call me back yelling about how I should have told you more. I’ve told you all I know. And don’t ask to see an imaging study rather than a patient. No patient is summarized by an MRI. I want your opinion on a patient, not a film. I already have a radiologist.

Finally, I know we all hate EMRs: you don’t have to tell me, I get it. But don’t give me a note that is either so full of incorrect and irrelevant filler as to be useless (“tobacco cessation advice given”. Really? She never smoked in her 82 years.). And don’t give me one so short that it’s great for billing and useless for anything else (“Exam: blah, blah, plan procedure code number x.xx”).

Medical specialists are not technicians; they are highly trained and highly paid professionals, and they should be treated that way. And they should behave in a way that reminds us that this is true.

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  1. Brilliant post!!! As a a family physician, I’ve had similar experiences. Very frustrating at times.

  2. I enjoy your posts, but I found this one to be especially interestingā€¦thank you for showing another perspective to the frustrating path many of us are dealing with in the current medical climate. Like Dr. Mom and yourself, we EM docs also deal with a lot of frustrating interactions. Ugh!!! LOL

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