Dumb Consults Thread

[thisampgoestoeleven]

I thought I could handle anything with fellowship, but I'm finding that the dumb consults on hematology are killing me.

Intern: "Patient is here with sepsis, just got chemo 2 days ago. We want you on board. We don't have any question and he's rock stable."

Attending: "How do I use a DOAC, again?" -- Sure let me uptodate that for you.

Surgeon: "This patient must have a bleeding disorder! I never saw bleeding like this before." [2 hours later, arterial bleed is localized]

I know this is temporary, and I realize that as a community doc this is the stuff that puts your kids through college, but as a fellow it makes me want to jump off a very tall structure... Maybe the Burj Khalifa.

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[whoknows2012]

I thought I could handle anything with fellowship, but I'm finding that the dumb consults on hematology are killing me.

Intern: "Patient is here with sepsis, just got chemo 2 days ago. We want you on board. We don't have any question and he's rock stable."

Attending: "How do I use a DOAC, again?" -- Sure let me uptodate that for you.

Surgeon: "This patient must have a bleeding disorder! I never saw bleeding like this before." [2 hours later, arterial bleed is localized]

I know this is temporary, and I realize that as a community doc this is the stuff that puts your kids through college, but as a fellow it makes me want to jump off a very tall structure... Maybe the Burj Khalifa.

if this is potentially your career buckle up. If this is a temporary fellowship bump in the road deal with it like the rest of us; occasional passive aggression, drinks after work and realizing that it’s only for a short time

 

[rokshana]

I thought I could handle anything with fellowship, but I'm finding that the dumb consults on hematology are killing me.

Intern: "Patient is here with sepsis, just got chemo 2 days ago. We want you on board. We don't have any question and he's rock stable."

Attending: "How do I use a DOAC, again?" -- Sure let me uptodate that for you.

Surgeon: "This patient must have a bleeding disorder! I never saw bleeding like this before." [2 hours later, arterial bleed is localized]

I know this is temporary, and I realize that as a community doc this is the stuff that puts your kids through college, but as a fellow it makes me want to jump off a very tall structure... Maybe the Burj Khalifa.

I get it...I would roll my eyes at the stupid sugar consults as a fellow ...still not my favorite thing, but in a day with crazy complex, not a clue consults, the control the pts sugars while in the hospital are a little breather since they really are so easy.

 

[DoctorDontStop]

I thought I could handle anything with fellowship, but I'm finding that the dumb consults on hematology are killing me.

Intern: "Patient is here with sepsis, just got chemo 2 days ago. We want you on board. We don't have any question and he's rock stable."

Attending: "How do I use a DOAC, again?" -- Sure let me uptodate that for you.

Surgeon: "This patient must have a bleeding disorder! I never saw bleeding like this before." [2 hours later, arterial bleed is localized]

I know this is temporary, and I realize that as a community doc this is the stuff that puts your kids through college, but as a fellow it makes me want to jump off a very tall structure... Maybe the Burj Khalifa.

This is mid first year fellow burnout Bro, I'm feeling it too. In the beginning of the year we were unsure of ourselves and probably second guessed what to do with each consult, treating each as a learning experience. Now that we have some steam behind us, stupid consults are just non-intellectually stimulating paperwork. I keep telling myself that in private practice it will be better, that some of these "consults" will go away when a primary attending can bill for the work up instead of consulting for simple issues. Or, if an attending has a question, they'll call for clarification instead of you having to spend more time in the hospital. If nothing else, at least we'll be better compensated for our trouble. Cheers.

 

[gutonc]

You’ll actually get more of this stuff out in the “real world”. But you’ll come to view them as what they truly are...a boat payment.

I railed against this crap as a fellow and early in in my attending life. But now I’ve completely flipped it. For the obvious BS, I have a couple of hours each week set aside for them. I do 15 minute new patient appointments (vs an hour for real problems). I squeeze 3 or 4 of them into that hour. I pan-lab them and tell them I’ll call when the results are back and then make any needed follow up then. Bill a 99204 based on “complexity” and call it a day.

For the hospital consults asking to talk about treatment/prognosis for a newly diagnosed cancer just before discharge, I spend 5 minutes looking at the chart, go up to the floor and introduce myself, tell them the diagnosis and whether the treatment will involve chemo, surgery or radiation and then give them my card with their appointment written on the back. I don’t bother to document these because they pay worse than an outpatient consult so I’d rather bill that way.

Using this method, I saw 4 “new consults” in 30 minutes during lunch today. I did that work for “free”, but it keeps my referring docs happy and will lead to plenty more work down the road.