Friday, August 20, 2004

The Lateral Dump...
The good Dr. Rangel has picked up the pet peeve ball and run with it. He tells the story of an orthopedic surgeon who admits a patient to their service, operates on that patient, and during the hospitalization transfers the patient to Dr. Rangel without clearing it. Dr. Rangel has two beefs with this: he wasn't called and the patient was uninsured.
I wholeheartedly agree with Dr. Rangel that the orthopedist owed him a phone call (at least) to discuss the transfer. The actions of the orthopedist in that regard are disreputable to say the least. Dr. Rangel had every right to refuse the transfer.
As for the second issue I wonder, did the orthopedist consult other physicians for medical management of his insured patients or not? If he did then that is a big problem. If Dr. Rangel finds he and his associates are only getting the "self-pay' crowd then that is a problem that must be addressed. Selective referral is a widespread problem with everyone, not just surgeons. One point not made is that surgical procedures fall under what is known as a "global period", usually ninety days. So opposed to a consultant for medical management that can submit a daily visit charge on a postoperative patient, the operating surgeon cannot for "usual" postoperative care.
I have often asked for a medically complicated patient to be admitted to his PCP or the staff medicine service rather than to my service. It works well for me because I don't do a wallet biopsy prior to making the decision and I evaluate the patient in the ED at that time and take them to the OR right away if need be.
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