I think in a nutshell, the moral of our story is that you should have a good working knowledge of who you send your patients too.....be it Ophthalmologist, Podiatrist, Internist etc.
I have become convinced more and more over the years that a particular degree means little. There are bad eggs everywhere and assuming that someone is good based on a degree might be a mistake. Knowledge is but one facet of a good clinician. If they are going to keep my patient in the waiting room for 3 hours, make them wait 3 months for an appt., talk down to them, talk down to them about me, not explain themself etc.......I don't need them and we will find another excellent surgeon.
I've discussed a fellowship trained glaucoma Ophthalmologist that I had always referred to (out of necessity mostly) that I got a chance to follow around in the clinic for a few days. I was shocked to see that he viewed every nerve with a direct ophthalmoscope, never pulled out a 79/90 and only picked up a BIO two times out of a few hundred patients.
I always wondered why he graded c/d's differently. I was dumbfounded to find a specialist who either didn't care, was incompetent or both. He had very poor chairside skills. He talked WAY over the patients head......asking one if they would like a retrobulbar block or local anesthetic for her next cataract surgery (a 83 y.o. disoriented lady that had no clue what he was saying). After repeating this a few times is the same works, the poor lady just said, "whatever you think is best doc"
He spent an average of 3.5 minutes with each patient (I timed him with my watch). But that's just this guy. I've actually gotten alot of patients from him over the year.
Of course, I've seen plenty of OD's with 2 inches of dust on their BIO because they have never been used so I'm not really pointing fingers at anyone other than this guy.
Thus, I have found it very useless to refer out to this guy unless we are ready for surgery and then I have to twist his arm to do it. I try to get people up to Duke now, if possible. I'd rather have a resident practicing on my patients than this guy.
I enjoy glaucoma, enjoy taking the time with people (which is what many of them need......recent studies show that most glaucoma patients don't really understand their disease and how they are really treating it). And it is relatively lucrative BTW. I truely feel that I provide them better care than this specialist (of course unless surgery is necessary). I think I care more than he does.
But back to comanagement. If I was a surgeon, I wouldn't want to have a blanket comanagement policy. I'd absolutely make sure I visit and observe everyone I sent to and encourge them (most have) to visit me. I don't want any discomfort on either side. If the surgeon turns me down on a request to visit him, he/she is either hiding something or is just an anti-OD zealot
No problem either way because I need to know so I can move on to someone else (there's always someone else.
