Friday, September 29, 2006

I'm probably going to make some of my readers angry by posting this, but what the hell...
First off let me say this is not an attack on physician extenders (NP's, PA's) whatsoever. I have a NP working with the trauma service and they are more helpful than the residents are. Some of the extenders are more capable than the physicians who supervise them. They also work in underserved areas delivering care to those who otherwise might not receive it.

This is a beef I have with some physicians who utilize them, IMHO, in an unprofessional manner. The basis of this is the growing (some may say epidemic) communication problem among physicians today. We don't talk to each other. It is a rarity that I receive a call from a physician asking me to consult on a patient. More often a clerk calls me or my answering service. In fact some physicians act irritated when I ask for them to call me to discuss the patient. But that is the subject of another post entirely. My problem lies with those who think the great unwashed among us are not good enough to speak with them, but have to appeal to their extender.

For example, a gynecological subspecialist has an very capable NP who works for him. She takes his calls at night and runs his service when he is out of town. If a patient is known to have a general surgical problem prior to their gynecological surgery (gallstones, for example) and a cholecystectomy is required, the physician himself does not call, the NP does. If an intraoperative consult is needed, the same applies. If I attempt to call this physician, I am not given the opportunity to choose to speak to the NP or the physician, I must speak to the NP who will pass my message along. I may or may not get a callback.

With others, sometimes days go by without an attending presence on the chart. Are my treatment plans and recommendations reaching the appropriate person? With "backsigning" of the notes, I can't tell.

Am I being petty? Maybe. But when I extend the courtesy of a phone call about a patient to a physician (rather than going through the unit clerk as described above) I expect to speak directly to the decision-maker.

Ok, diatribe over.
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