Just to clarify what I think you intended to say....
I must disagree with WS. This was the time to ~starr and shake. Definately the time to ~starr for sure, might have gone overboard with the shake. It would be a shame to miss the opportunity to have "starred". Must have been in Boston.
I am curious about this as well. When did it become in vogue? I don't recall it being part of the ABS exam or even to review courses ~ 2years ago. I never use it and have not been using it. Is it some university SICU & ID attendings' pet project/area of research?
Seems like it originated from a 2004 study using multiple regression. They probably picked some independent predictors of nec fasc, did some statistical magic and came up with a score threshold.
Great, Singapore, 2004.... I never used it, discussed it, or saw it applied through GSurgery residency. Didn't see it used in the boards just a few years ago... So, is it something now standard? Are residents routinely using and/or discussing it when taking consults and/or rounding in SICU? Or, are residents getting called for consults with a medicine resident at the other end of the line using a formula that "we" don't use? Is it part of ABSITE? Is it now showing up in review courses? I am being serious cause it really is fairly unusual to me. New things happen in residency all the time. I would be curious to know if this is now a component of the basic science being learned.
FoundOnLine said:
Thanks for the lead. Here's what I've found:
That is where I stood on the matter. It doesn't seem to have changed all that much.
I usually just look at the wound, look at the patient and call the attending.... woops, that's me!
Actually, not really. I don't know if I know anyone at the ER in question. But, my general experience has been thus. The ED attendings push for a very informal and friendly atmosphere. Where I trained, it was not uncommon for ED division/department (~entire department) to party and get smack faced drunk with the entire ED residency. The ED attendings would insist on first name only. Then, with students, they would encourage "pro-active" conduct. "Pro-active" was like the ED's version of the passive aggressive excuse used by nurses.... "I 'm a patient advocate". I keenly recall that word, "pro-active" being thrown around a dozen times a night during general surgery residency. The ED would very commonly back the independent consult calling on the part of MS4 and would usually have their back if it got a consultant's hairs all in a fro. However, invariably a real foolishy and agregious consult would occur like the one described... Then, I saw the ED back away and leave the MS4 to take the hit for the team.
Actually, what you are describing is not a gatekeeper but a "vault" keeper. It is well known in the community that this practice is a method by which the hospitalist directs funds to their friends. Their friends.... I am certain are NOT upset by this practice cause they make bank every time they round... or used to. Non-procedural specialists make (or used to) their wealth off of these 3 page initial consults followed by daily rounding. I don't know how the new consult code issue will effect the medical folks and this corrupt practice of milking the healthcare system.
My friend who does residency in a community program told me about this phenomenon. In fact, whenever a patient got admitted, the consultants buzzed around them like bees to honey. One attending had to ask repeatedly for a consultant to stop writing notes on a patient.
Never underestimate the lengths a student will go to and the risks he'll take to get that A baby.
I don't know if the practice will continue. However, if it is $50 per head, I suspect they will continue. More often then not these "requests" are for things described.... mild COPD, relatively controlled hypertension/DM/etc... Consultants will have boiler plate notes and quick fill ins for their notes. It would be ~$50 x 10-20 patients for about 5 minutes each.
I sensed that immediately
I am not going to spend much time trying to spell it out.
I will leave it to you to ponder as to how the current system is funded and monies distributed. There is money in socialism too. Socialism does not eliminate fraud or waste nor does it stop gaming of the system. I am not going to type beyond that; not my intent to turn this thread into full blown sociopolitical thread.
I agree... it is often not worth it for us that depend on ~procedure based care. However, medicine/non-procedure folks can sweep through ten patients in under an hour or two. They also do not have to squeeze in full OR days and post-ops. They also do not normally come rushing in for consults (maybe cards and ACS). So, for them, it makes money and sense.
) are micromanagers. Do not discharge the patient if you are not the admitting service as it implies responsibility for all other problems which may not be surgical. You might get dropped from the case but it may still incur substantial emotional and financial costs.Did the radiologist call anyone to notify them of the nodule? Just curious, because they often seem to get named as well.Funny you should mention that.
I was just talking to a friend last night about exactly this situation.
He was consulted on a patient with abdominal pain; the patient was admitted to the Hospitalist Service and underwent surgery. Apparently on chest x-ray a lung nodule was seen. Patient decides to sue because he was discharged without having the lung nodule mentioned to him. The surgeon was sued as the patient claimed he was the attending physician and it was his responsibility to notify the patient of the results of the CXR (ordered by the hospitalist) and to do the work-up. Hospitalist claimed he was not responsible because the patient was admitted to the surgeon post-op.
Fortunately, the record from the ED and the medical file showed that the patient was indeed admitted to the Hospitalist and that the order from the resident post-op to "transfer to ICU" was not a transfer of attending. The surgeon (a friend of mine) was dropped from the suit.
Other physicians will leave the ship like drowning rats and point fingers in the case of a lawsuit and do anything to protect themselves. Lesson for the residents: when writing orders on patients who may have other consultants involved - make sure what your attending intends (stay on other service, or admit to surgery) and make sure all tests, even those you didn't order have some follow-up plan. This is why surgeons (even male ones
Yes, very fortunate. Something like a missed nodule on an admit chest xray often bites a surgeon that provides care. Even if he/she did not order the film, it is data probably available at the time consult rendered, prior to surgery. Further, numerous textbooks still list chest xray as an important and/or standard study prior to surgery. Thus, the expectation that the surgeon would have had a responsibility to rebiew the film even if they had not ordered it.
