Best Academic Consultations

In terms of general surg path, personally I am REALLY disappointed of the utterly crappy service most Academic departments provide.

If I did biz like them, I would be pulling down a crap 150K salary, living in a POS condo and driving a beat up 85 Hyundai.

In terms of West Coast centers:
UCSF is the best of the bunch, the fellows call. Keep me updated etc.
UCLA surg path is so so, still nothing to write home about.
San Diego is non existent communication.
Stanford is abysmal. Im mean seriously WTF are they smoking, it is impossible to get a straight answer from the fellows. MAN THE F- UP and get the case signed out.

Others
UMich is decent, still takes too long but I do occasionally get a call from the fellow.
Brigham faxes me a handsigned prelim from the attending like the next day. Ummm. WTH. How can I get a Dx from across the US the next day and its likes 2 weeks to get any sort of communication from Stanford/SD etc...
Hopkins: the answer is practically ESP'd into my brain after I even think of sending the case. You get the picture.

The take home from this post is CALL the referring pathologist when you have a case that takes longer than 24hrs so he/she doesnt think you are a douche.

Have a strong phone voice and be confident...seriously you make a very bad impression sounding like you are about to weep while telling me you have no clue what the Dx is...

Im getting to the point I feel its almost pointless to send anything in consultation unless it goes to Harvard, which is sad because Im not a fan of Harvard..

LADoc00 said:

In terms of general surg path, personally I am REALLY disappointed of the utterly crappy service most Academic departments provide.


In terms of West Coast centers:
UCSF is the best of the bunch, the fellows call. Keep me updated etc.
UCLA surg path is so so, still nothing to write home about.
San Diego is non existent communication.
Stanford is abysmal. Im mean seriously WTF are they smoking, it is impossible to get a straight answer from the fellows. MAN THE F- UP and get the case signed out.

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perhaps you might have gotten jipped from a few particular fellows (i apologize on their behalf), but we always call dx, along the way in process and again before a final dx is achieved, and all this while dealing with a very heavy load of cases.

SLUsagar said:

perhaps you might have gotten jipped from a few particular fellows (i apologize on their behalf), but we always call dx, along the way in process and again before a final dx is achieved, and all this while dealing with a very heavy load of cases.

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Tip: dont call someone and say: "Well, I think it is Epitheloid Hemangioendothelioma (for example) but I need to show it to 5 different attendings because no one person is able to make a decision. I may call you back in say 3 weeks when these 5 people arent on vacation or sabatical. Until then good luck!"

Dont do that. And no you dont always call or else my phone lines are cutting out all the time.

Seriously, I feel like some sorority chick who's BF on the football team claims he will call and never does and Im sitting by the phone pouring my soul out to some secretary because the surg path fellow in on their 20th Starbucks break of the day.

I signed out a hundred surg path cases yesterday after having to help my staff process the blocks by hand because our machine exploded. Dip a couple hundred blocks in formalin and xylene and then tell me heavy load crap.

MAN UP. Just man up and get it done. Then go to PF Changs and get some cocktails and digits from the hot waitresses. Dont do it DURING the work day.

By the way, what do you like in consultations? Do you just want a diagnosis or do you want the full letter with all the comments and descriptions, etc? Seems like consults vary a lot across the country in that fashion. Have seen some where it's basically just a two word consult report. Others are two pages long and give clinical relevance, differential diagnosis, etc.

yaah said:

By the way, what do you like in consultations? Do you just want a diagnosis or do you want the full letter with all the comments and descriptions, etc? Seems like consults vary a lot across the country in that fashion. Have seen some where it's basically just a two word consult report. Others are two pages long and give clinical relevance, differential diagnosis, etc.

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I want a Dx.....A DX, I dont care about your 2 page flowery description of friggin lymphocytic colitis.

How about this, LADOC: "Dr. Appleman, is this lymphocytic colitis?"
UMich fax 24hrs later: "Yes."

Dont patronize me, I dont give a crap how you feel about steroids in microscopic colitides...I dont care. Seriously.

The funny thing is I see the people from Mich more than any other academic institution, they were just living it up in Santa Barbara last month (and before that the Palace hotel in SF, Chicago, etc etc), so Im not sure who is signing out their cases, must be you Yaah. Good job!

Yeah that's what I thought. People vary here. The GU people here basically give dx + small comment.

I've always been interested by the timeline thing too though. Mayo has a great system for consults, I think they have a special contract with Fedex or UPS or whatever, their consults arrive by plane at like 5am, they are accessioned and to the attendings by 7am (something like that). They also have vans that go around various areas to pick up consults and ship them.

Here stuff comes in all over the place, eventually it gets routed to the people who accession cases, then to the specific attending's secretary, then finally to the fellow or attending (sometimes this is hours after the package originally arrives). It's not a streamlined system yet because sometimes the slides will come directly to the attending's secretary, but she has to send them over to the accessioners who then have to think about it for awhile before accessioning and then sending them back. And most attendings here don't call unless it's something really weird. But our AP director calls on every single case as soon as possible - he organizes his consults based on what time zone they are from and who he knows that leaves the office early in order to do this better. It is rubbing off on some people but not others.

Can you send people to California because its getting crisis levels here in terms of disorganization...

There's plenty of disorganization here. Disorganization is the natural state of things for most academic departments. Some people have their own little worlds carved out where they can create order amidst chaos, but they can't do much at all about the world outside their door. As I said, the consultation process depends on everyone doing their job, and that includes a bunch of people who don't really care how fast things happen (like transporters, accesssioners, etc).

LADoc00 said:

Can you send people to California because its getting crisis levels here in terms of disorganization...

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we've got probs in accessioning, which i'm sure others do as well. they'll often come to us midday for case that came in the morning to "code" the case (i.e. SP vs neuro vs heme vs derm consult) and THEN they go back and accession, label slides, etc. We basically get the case in the evening. But things are improving though.

SLUsagar said:

we've got probs in accessioning, which i'm sure others do as well. they'll often come to us midday for case that came in the morning to "code" the case (i.e. SP vs neuro vs heme vs derm consult) and THEN they go back and accession, label slides, etc. We basically get the case in the evening. But things are improving though.

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Hold it hold it, you not Stanfording it.

Follow these steps:
A.) Whenever someone claims something at Stanford is amiss, they are immediately deemed a-holes. So I would properly be addressed as Dr. A-hole.
B.) Their criticisms stem from being intellectually inferior OR simply not being culturally diverse enough to know how things work at the Farm.
C.) Never apologize for anything Stanford does, StanfordU is always right as Governor Leland Stanford was in the railroad and oil booms.
D.) Stanford can "sense" you are dissing it and if you are close enough you will pay the price..you will pay.
E.) Things cannot be ever "improved" on, Stanford was perfect from the moment it was founded in 1885...Die Luft der Freiheit weht
F.) Joe Lieberman is a right wing radical in Stanfordese, Joe Stalin was fair and elgalitarian.

The best consultants are ones that treat their consultees as colleagues. There is so much disdain for community pathologists in academics (which has mostly got to be driven by perceived discrepancies in $$$).

For instances, one guy told me that he sends all borderline low grade gliomas to Peter Burger at Hopkins for initial grading as well as rare brain tumors. He says Dr. Burger frequently calls him personally with each diagnosis. Also if he needs more clinical info or the block for immunos he also calls and speaks with the pathologist. That's the way it should be done. Delegating all that stuff to residents, fellows and secretaries ensures stuff getting dropped through the cracks. Plus Burger is building relationships which will guarantee him getting cases sent to him for decades from those people.

is Mayo. They pretty much call you the day they get the case, and a faxed report is usually in your hands the day after.
I love the Mayo's consult letters, too. They always start with something along the lines of "Thank you for sending this interesting and challenging case . . ." The next paragraph usually begins with this statement: "We completely agree with your diagnosis of _________." Sometimes I'm even left scratching my head, because I wasn't even certain that was in my differential diagnosis.
The docs at Mayo must receive training in customer service, because they sure are good at it!