Ccs questions

[babycatcher08]

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is there any point in ordering a consult? do they ever give you advice? one case i did the patient needed removal of a foreign object, but the pulmonoloist had no recommendations. another time i had a patient with 75% cartodid stenosis who needed carotid endarterectomy. the surgen said there were no recs. should i just skip consulting and just order the bronch and surgery?

 

[Reaganite]

is there any point in ordering a consult? do they ever give you advice? one case i did the patient needed removal of a foreign object, but the pulmonoloist had no recommendations. another time i had a patient with 75% cartodid stenosis who needed carotid endarterectomy. the surgen said there were no recs. should i just skip consulting and just order the bronch and surgery?

I had a couple of cases on my exam where a patient needed a surgery--ruptured AAA, ectopic pregnancy, pneumoperitoneum--and all I did was consult surgery and each time my consult read "Surgery scheduled. Continue expectant management." So I'm assuming that this is all you have to do. I don't think you request the specific surgery. One thing to be careful about is to know who to consult. On my ectopic pregnancy case, I initially consulted ob-gyn assuming that is who would do the surgery. All I got was the "no recs" response. Initially, I though wtf?, but then I ordered the surgery consult and after I got their response of schedule a surgery, the case ended. Now that you mention it, though, if I remember from the practice cases, there was a case where a patient had a tension pneumothorax, and you actually had to order the specific intervention rather than consult surgery. So I guess in the end, it depends on the specific case. If you know, for example, that a patient will need a surgery, then try ordering the surgery consult. If this doesn't work, then see if you can order the specific intervention or vice versa.

 

[dieulafuoy]

it depends on what procedures a family physician is entitled to perform. A thoracentesis in pneumothorax can be done by family doctor but not an abdominal surgery in case of ectopic rupture

 

[MeowMix]

you have to order a consult in e.g. surgical abdomen, or an oncology case. The consultant usually does not do anything, but you get the point for ordering the consult. There were some UW cases where in order to get the procedure done, you had to order the consult, but I don´t think I had any on my exam like that.

 

[hippiedoc13]

Sometimes I think they really do expect you to get the consults, even though the consult never tells you what to do. On my exam there was a pregnancy case in which the correct management was delivery (but not necessarily a c-section). I was going along managing the case appropriately, knew I was doing everything right, couldn't figure out why the case wasn't ending. I am a family med resident and was operating in that mindset, and it never occurred to me that I would need to consult anyone else to deliver this kid. Then it dawned on me that maybe they wanted me to consult OB. Sure enough, as soon as I entered the OB consult (which said nothing), the case ended.