old_boy

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I recently had an experience where I wish I'd had an audio recording of an interaction I had with a consultant, and it got me thinking if it would be possible / advisable to record/log through a recorder in my scrub top pocket the audio from all of my shifts for CYI purposes.

The situations was that a patient at 1am comes in with a simple 2cm facial lac. She says "I want a plastic surgeon to repair it". I call plastics on call, tell situation and say something along the lines of "pt is refusing to have me close the lac, please come in to repair the lac". He refuses flat out, states he doesn't come in to close simple lacs, gets angry, tells me to close the lac or dc her if she refuses, hangs up. I tell patient that plastic surgeon has stated he won't come in to close lac, she consent to me closing the lac which I do. One month later I hear from my medical director that patient filed a complaint that she requested a plastic surgeon and her request was refused. The plastic surgeon denied knowing of the case, denied ever being called. A complete lie.

Fortunately, my med director was understanding, believed me, and situation blew over without incident. But it made me think that if I'd had an audio recording, I could have nailed the consultant for lying.

Of course, I could have played hardball and demanded a consult from the plastic surgeon and called the medical officer on call if he refused, but seemed petty considering it was a relatively superficial lac, easily closed in the ED, I understood why the plastic surgeon didn't want to come it. It's just disappointing that he completely threw me under the bus and denied that we ever spoke. If I'd had an audio recording I could have at least proven that I'd spoken to him.

What do you guys think?
 

southerndoc

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We use PerfectServe for all our communications. Everything is logged (if you paged, if you called directly through the app, etc.). Doesn't record the conversation, but it has a record that you called.

Be cautious of recording conversations. My state (Georgia) only requires one party to know you're recording, so you'd be ok recording from a state legal perspective since you are a party to the conversation. Some states, however, require that all parties in a conversation know and consent to being recorded. So you could get into some deep trouble if you record a conversation with a consultant and he/she not know of being recorded and you are doing so in a state that requires dual consent.
 
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EKGdoc

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Did you put some documentation in the chart about your conversation with the plastic surgeon? I doesn't have to be inflammatory, just something like "patient requested plastic surgeon for repair. Discussed with Dr. X, on call for plastics, who felt based on my description of the laceration, emergency physician should repair. Discussed with patient, who agreed/consented with my repairing the laceration." Doesn't throw anyone under the bus and covers your butt. (Now for wounds that you're not comfortable repairing, that's another story). Patients think they can "demand" a plastic surgeon for every minor laceration- you have to come up with a nice way of telling them it's not McDonalds and the world doesn't work that way.
 

Birdstrike

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I recently had an experience where I wish I'd had an audio recording of an interaction I had with a consultant, and it got me thinking if it would be possible / advisable to record/log through a recorder in my scrub top pocket the audio from all of my shifts for CYI purposes.

The situations was that a patient at 1am comes in with a simple 2cm facial lac. She says "I want a plastic surgeon to repair it". I call plastics on call, tell situation and say something along the lines of "pt is refusing to have me close the lac, please come in to repair the lac". He refuses flat out, states he doesn't come in to close simple lacs, gets angry, tells me to close the lac or dc her if she refuses, hangs up. I tell patient that plastic surgeon has stated he won't come in to close lac, she consent to me closing the lac which I do. One month later I hear from my medical director that patient filed a complaint that she requested a plastic surgeon and her request was refused. The plastic surgeon denied knowing of the case, denied ever being called. A complete lie.

Fortunately, my med director was understanding, believed me, and situation blew over without incident. But it made me think that if I'd had an audio recording, I could have nailed the consultant for lying.

Of course, I could have played hardball and demanded a consult from the plastic surgeon and called the medical officer on call if he refused, but seemed petty considering it was a relatively superficial lac, easily closed in the ED, I understood why the plastic surgeon didn't want to come it. It's just disappointing that he completely threw me under the bus and denied that we ever spoke. If I'd had an audio recording I could have at least proven that I'd spoken to him.

What do you guys think?
Ahh....that sucks. Recording is not likely to be practical. Great idea though. Like Southerndoc say, check your state law before attempting. Also, how/where are you going to store all these conversations, it must be hipaa compliant way/place to store them, etc. Not likely practical.

Since face lacs can be closed in up to 24 hr, one option to think about is to get the patient and plastic surgeon to both agree that they get seen in the surgeons office that morning, within 24 hr, to close it. I wouldn't want to come in a 2 am to close a face lace a med student could close, either. That's complete BS. It's no different than if you're off post nights, and your partner calls you, 2 hr into you post shift sleep, and says, "Some jerk patient is refusing to let me stitch them up. They want you to come in, now. You sewed them up last year and did it perfect." No way.

This is a case where the patient is refusing emergency care, and demanding something unnecessary, and far above that.

Option 1- Emergency doc sews it up.

Option 2- Go to plastic surgeons office within 24 hour, but probably will have to pay hundreds, if not thousands of dollars up front to have the lack repaired. I cannot guarantee what his billing practice will be, or if he'll even do it if you can't pay.

Option 3- Transfer patient to another facility with a "higher level" of care, where there is a plastic surgeon on duty, that agrees to repair the lac. This is not a good option for various reasons. It could even risk EMTALA issues if the plastic surgeon on the other end finds out your surgeon refused the patient, and he got stuck coming in a 2 am, and that it was a bs transfer and likely refusal to provide care.

Option 4- If your director isn't going to back you up retrospectively in these situations, he needs to be available at 3 am, or some "administrator on call" needs to be available to help you out, get on the phone with the patient and plastic surgeon, at 3 am, to handle it prospectively. If they're going to foster and environment that rewards and encourages entitled ridiculousness, they need to administratively back that up in real time, when the so called "crisis" is occurring.

Emergency Departments are not emergency departments anymore. They're something entirely different. I don't know what the appropriate name for them is, but "emergency department" clearly is a misnomer. These examples are classic evidence of the law of unintended consequences of the Law of EMTALA. Its a law that was intending to prevent hospitals from dumping patient's who were having true emergencies on the streets, the classic example of which was a woman in labor whose care was refused and ended up dying. It was not designed to allow patients to manipulate the system to be an all hours, 24/7/365 concierge-on-demand service, but that's how its been abused. The results are that ED staff are stuck in the middle trying to sort through the insanity of it all. Thanks for doing what you do.
 

docdragon

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We are the Department of Unscheduled Care and Critical Illness. Always DUCCI in the ED!

Or if you prefer, the department of big shoulders, the place of constantly available doctors. The generalist who is a specialist. The gatekeeper and the child soother. The first, second, third, and ninetieth opinion, the pre-surgical consult and the post-surgical check. The person who plugs the hole whether from a GSW, broken heart, or failed sociopolitical experiment.
 

Birdstrike

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We are the Department of Unscheduled Care and Critical Illness. Always DUCCI in the ED!

Or if you prefer, the department of big shoulders, the place of constantly available doctors. The generalist who is a specialist. The gatekeeper and the child soother. The first, second, third, and ninetieth opinion, the pre-surgical consult and the post-surgical check. The person who plugs the hole whether from a GSW, broken heart, or failed sociopolitical experiment.
Lol. I love that one.

"The Department of Failed Sociopolitical Experimentation."

We have a winner!
 

link2swim06

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Our hospital records calls involving any transfers to outside hospitals...not between doctors on staff at our hospital though.
 

Tiger26

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If we go through our admission referral phone then the entire thing is recorded, though I'm not sure how long that lasts.

I don't know about everyone else, but I always document who I talked with and their recommendations. One of the consultants was recently displeased with that, so I'm wondering about you guys, but I was trained that if it's not documented somewhere then it may as well not have happened.
 

WilcoWorld

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If we go through our admission referral phone then the entire thing is recorded, though I'm not sure how long that lasts.

I don't know about everyone else, but I always document who I talked with and their recommendations. One of the consultants was recently displeased with that, so I'm wondering about you guys, but I was trained that if it's not documented somewhere then it may as well not have happened.
As long as it's being done professionally (non-inflammatory) than this is a very good practice.

Also, anyone who is uncomfortable going on the record with his or her medical recommendations is untrustworthy, which means I DEFINITELY want to document those conversations.
 
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erdoc00

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Ah the old "I was never even called about this patient"... cousin of the "but...but...but... if they wanted me to come in that bad, they should've told me to come in"

These consultants have zero integrity. You want to be a big jackass on the phone, fine... but own your decision and stand by it. Don't be a coward and a weasel after the fact with these laughable excuses .
 
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Tiger26

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Agree--one of two options:
1) I write in the note that we talked and ______ is the recommendation
2) You come in during the middle of the night when I happen to be working and see the patient yourself
 

gutonc

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My feeling is that if you (as the consultant) don't like that I'm writing down what you've told me over the phone, or think that I'm somehow writing it in a way contrary to what you would like, then you should come in and write your own damn note.
I routinely do this as the consultant because of the number of times that I've been misquoted in the medical record (usually, but not always, unintentionally). I may not come in, but I will document the conversation we had from my perspective. I also include my pager # in these notes and a request to contact me with any questions or concerns. It's rare that this is ever an issue, but when I'm on call on a weekend, I cover 9 hospitals over a 4 county area, and getting in to evaluate a patient may mean 4 or 5 hours. If they're sick enough to come in, they probably need someone to be at the bedside sooner than that. So I usually leave a note in order to communicate to the hospitalist or ICU doc what I'm thinking until I can get there and assess the situation for myself.

Also, on those rare occasions when I think I'm going to get push back when I call, I will use my primary hospital's consult line as the callback #. It's a recorded line and that usually smooths things out from the get go.
 
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WilcoWorld

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I routinely do this as the consultant because of the number of times that I've been misquoted in the medical record (usually, but not always, unintentionally). I may not come in, but I will document the conversation we had from my perspective. I also include my pager # in these notes and a request to contact me with any questions or concerns. It's rare that this is ever an issue, but when I'm on call on a weekend, I cover 9 hospitals over a 4 county area, and getting in to evaluate a patient may mean 4 or 5 hours. If they're sick enough to come in, they probably need someone to be at the bedside sooner than that. So I usually leave a note in order to communicate to the hospitalist or ICU doc what I'm thinking until I can get there and assess the situation for myself.

Also, on those rare occasions when I think I'm going to get push back when I call, I will use my primary hospital's consult line as the callback #. It's a recorded line and that usually smooths things out from the get go.
I think that EP's worth their salt are able to convey an accurate clinical picture to a consultant. Maybe that can't tell you which type of renal tubular acidosis the patient has, but they should be able to tell you if the patient is acute and why your help is needed. If all of my consultants would drop a note whenever we talked about a patient, well, that would be lovely.

BTW: If I think a consultant needs to come see a patient, I lead with that information ("Hey Gutonc, it's Wilco. I hate to bother you, but I've got a patient in room 12 who I'm going to need you to come and see. He's an XYZ with PDQ...").