JustPlainBill

Attending
10+ Year Member
Jan 5, 2007
2,568
2,933
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Attending Physician
So --- I'm in a multi-partner practice that also has a few employed physicians and PAs/NPs ---

Being the new guy, my schedule of patients is usually not full -- I see anywhere from 9 to 19 a day --- very few of them my patients. We have a concept of "On-Call" that allows a patient with an acute illness to see a doc if they can't get in with their PCP/NP/PA -- well, usually it's an acute illness -- now it's more of a "convenience of the patient" type of thing and I've had to refill a few chronic med scripts and do DM f/u visits -- usual stuff.

However, there's another employed physician here and a situation is developing that I'm really not sure how to handle ----

Had a patient of theirs on my schedule one day for hematuria and LAP --- the UA was like a thick tomato soup and the patient was complaining of LAP x 1-2 days -- to me, that needs to be checked out with a scope to find the source of bleeding rather quickly -- so I tried to get them STAT into a urologist -- when that failed due to patient transportation issues, I recommended ER (which the patient had originally considered before presenting to clininc and quickly agreed to) ---- so it was handled (maybe not the best but handled nonetheless) and I had to get up to a mandatory meeting --- left it in the hands of my MA who knew what I wanted -- and I thought I was done.

I come back down from the meeting and ask about the patient -- only to be told that this other physician (patient's PCP) had pulled the patient into one of their exam rooms, ordered a different workup, ordered abx for hemorrhagic cystitis and was discharging the patient --- so I turned and asked about billing issues with seeing 2 FM providers in one day so we don't double bill the patient and I get told,"I don't care who bills them or gets the credit, I just wanted the patient to be taken care of" --- ok, so maybe I've got a chip on my shoulder, but I thought I had taken care of the patient and the plan was in place and workable until YOU stuck your nose in --- but it's her patient so ok, good.

From that point on, everytime I get one of her patient's I always ask if she wants them -- I've had situations where she would see one of her patients on my schedule and being roomed and intervene and take the patient if she wasn't busy.

So today, the original hematuria patient is doing a f/u visit but can't be sure when they'll be here -- so they're on my and the other physicians schedule -- depending on when they get here, that's who will see them. The other physician can't stay late due to commitments so I may get this one on my schedule or not.

How do you handle this --- this person has been condescending quite a bit and one time I turned around and flat out told them that I went to the same medical school they did (actually that's literally true) and passed the ACGME boards ----

Recommendations?
 

cabinbuilder

Urgent Care Physician
10+ Year Member
Nov 21, 2005
4,541
2,363
Texas
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Attending Physician
There is a reason I did locums for 5 years, Bill. So super sorry the suckfest is in your face every day.
 
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mark v

Junior Member
10+ Year Member
Dec 14, 2004
289
316
Ditto what BD said. My advice would be to build your own patient panel ASAP so you don't have to be the work in doc any longer. I was in a similar situation up until about a year ago. I came in to an established practice and took mostly workins. It makes for pretty unreliable numbers. I was building slowly and it was frustrating. As painful as it can be, when I opened up to Medicaid and started seeing anybody and everybody, my numbers drastically improved.
 

BJJVP

7+ Year Member
Feb 5, 2011
188
123
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Attending Physician
Why was the patient sent to the ED? Were you hoping that a urologist would see them in the ED or that they would be admitted for a workup?
 

VA Hopeful Dr

Senior Member
15+ Year Member
Jul 28, 2004
20,346
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Why was the patient sent to the ED? Were you hoping that a urologist would see them in the ED or that they would be admitted for a workup?
If you can't get a same day CBC (and urology within a few days), the ED is reasonable - had a patient in residency with urine just like that. Hemoglobin from 12 to 5 in a week.
 
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septoplasty

Exceptional
7+ Year Member
Nov 10, 2010
747
136
Call Room
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That sounds like a bad practice, I agree as above.

One of my best attendings told me that its only reasonable for reasonable physicians to have difference of diagnosis and management, which is what makes medicine, a practice. So you weren't wrong, and I would have done the same (in fact I have, with a similiar case in a younger male, from the UC to ED). Sounds like that physician had a problem with your management style. There also maybe some thought of you "borrowing/stealing" their patients, so they gave you some attitude.

Shrug it off and move on! No worries..
 

anthroguy

10+ Year Member
Jun 12, 2005
151
26
Status
Attending Physician
If a physician has a issue with the way a colleague is doing something, there's a way to bring it up and both parties involved can learn something. Maybe someone is right and someone is wrong, who knows. By his/her behavior, this "colleague" is a tool.
 

Doctor4Life1769

**tr0llin, ridin dirty**
10+ Year Member
Apr 28, 2008
34,255
902
Where the grass is always greener
Status
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I'm a newbie too and get work ins.
Nice thing is I'm the only newbie and nobody questions my judgment. My approach is starkly different too. I've taken patients of opiates and I'm procedurally heavy (joint blocks, tpi, skin lesion removals etc) and they like it. They also like that I bring a fresh perspective and the mid levels always enjoy learning from me (I don't teach or advise unless they ask me for help or have a question). I'm enjoying it, however I really am hating facilities. I especially don't like going out there and seeing pts and later having to type up notes while the senior physician doesn't do jack and gets to cash in on medical directorship. Hell im a doctor, and I'm willing to show up to QA meetings and monthly staff meetings, make me the director so at least I can attain the fruits of my labor. I'm not a mid level going to the facilities.
 

Doctor4Life1769

**tr0llin, ridin dirty**
10+ Year Member
Apr 28, 2008
34,255
902
Where the grass is always greener
Status
Resident [Any Field]
So --- I'm in a multi-partner practice that also has a few employed physicians and PAs/NPs ---

Being the new guy, my schedule of patients is usually not full -- I see anywhere from 9 to 19 a day --- very few of them my patients. We have a concept of "On-Call" that allows a patient with an acute illness to see a doc if they can't get in with their PCP/NP/PA -- well, usually it's an acute illness -- now it's more of a "convenience of the patient" type of thing and I've had to refill a few chronic med scripts and do DM f/u visits -- usual stuff.

However, there's another employed physician here and a situation is developing that I'm really not sure how to handle ----

Had a patient of theirs on my schedule one day for hematuria and LAP --- the UA was like a thick tomato soup and the patient was complaining of LAP x 1-2 days -- to me, that needs to be checked out with a scope to find the source of bleeding rather quickly -- so I tried to get them STAT into a urologist -- when that failed due to patient transportation issues, I recommended ER (which the patient had originally considered before presenting to clininc and quickly agreed to) ---- so it was handled (maybe not the best but handled nonetheless) and I had to get up to a mandatory meeting --- left it in the hands of my MA who knew what I wanted -- and I thought I was done.

I come back down from the meeting and ask about the patient -- only to be told that this other physician (patient's PCP) had pulled the patient into one of their exam rooms, ordered a different workup, ordered abx for hemorrhagic cystitis and was discharging the patient --- so I turned and asked about billing issues with seeing 2 FM providers in one day so we don't double bill the patient and I get told,"I don't care who bills them or gets the credit, I just wanted the patient to be taken care of" --- ok, so maybe I've got a chip on my shoulder, but I thought I had taken care of the patient and the plan was in place and workable until YOU stuck your nose in --- but it's her patient so ok, good.

From that point on, everytime I get one of her patient's I always ask if she wants them -- I've had situations where she would see one of her patients on my schedule and being roomed and intervene and take the patient if she wasn't busy.

So today, the original hematuria patient is doing a f/u visit but can't be sure when they'll be here -- so they're on my and the other physicians schedule -- depending on when they get here, that's who will see them. The other physician can't stay late due to commitments so I may get this one on my schedule or not.

How do you handle this --- this person has been condescending quite a bit and one time I turned around and flat out told them that I went to the same medical school they did (actually that's literally true) and passed the ACGME boards ----

Recommendations?
I've done what you recommended. I don't just assume cystitis when urine is like that especially if male. I don't think gender was specified though.