Sunday, May 15, 2011

The downside of primary care.

(A sure sign I'm working: several days of no posting, then a somewhat random post about something medical. But there you go.)

I love being a family doctor. I've talked before about how much I enjoy it, how I love taking care of the whole person and managing their chronic problems. Sometimes, though, that means being caught in the middle of several specialists with the unenjoyable task of playing human telephone.

An example:
I call up a specialist whom I've consulted on one of my patients:
"Dr. X, I'm calling concern my patient with this complicated problem that has gotten worse. What else can we be doing to make this problem better?"
"Well, I don't understand why Dr. Y hasn't done this procedure that I don't do. I really think he needs it. Maybe you could call Dr. Y and get him to do it."

Now I call Dr. Y.
"Dr. Y, this is Aubrey Tell with family practice. I'm calling about my patient with this complicated problem. Dr. X really feels like he needs this procedure."
"Well, I've been watching him for a few days and I didn't think we needed to do it yet. But why don't you call Dr. Z, the other specialist who can do this procedure."
[Insert editorial translation: It's saturday and I don't feel like coming in and doing it.]

Internally, I sigh and then call Dr. Z
"Dr. Z, this is Aubrey Tell with family practice. I'm calling because I have a patient who needs this procedure. Can you do it?"
"Umm...No. Have you even spoken with Dr. Y yet? Why is he not doing it? Why is he not doing the other procedure that would also be effective? I haven't done one in two years, so I would prefer if Dr. Y would do it."
[Editorial translation: I also don't feel like doing it on Saturday.]
"Well, Dr. Y wanted you to do it and we're not doing it the other way because we tried that already and there were complications."
"I'm really not comfortable doing it. Let me know if Dr. Y won't do it."

Another sigh, and I call Dr. Y again.
"Dr. Z says he hasn't done it in two years and is not comfortable doing it."
Exasperated, Dr. Y responds," Well, the reason he hasn't done one in two years is because he always refuses. I really wish we could wait because your patient has another related condition and I was really hoping to take care of everything at the same time."
"I don't know what you want to do, all I can say is that Dr. X felt like he needed this procedure soon."
"Alright, I'll take care of it tomorrow."

A relieved sigh and I am off the phone.
Wasn't that easy?

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