East coast GI/GU university consults Attendings input valued

[mcfaddens]

---

Members don't see this ad.

Hey this is a similar thread to one that SLUsagar's earlier posted on a similar subject. Here is my problem: Got a case, have a diagnosis, but its one of those dysplasia cases that the books tell you to have another specialist in the field sign off on in addition to your signature before a radical surgery takes place and my current academic referral takes weeks to get a simple second look at. Im frustrated about the TAT (turn around time). Who on the East coast (preferably I might know them) or nationally that has a good TAT on GI/GU cases. My post is directed to those familiar to getting a second name on a report and would know how fast they do it. There are some great consult sources out there but in certain situations like the one im in I need a good consultation infrastructure that can get the cases to the pathologist and back to me in a reasonable amount of time as opposed to sitting on the desk of a lazy office employee. Thanks for any input.

 

[LADoc00]

BrighamWH has had stellar TAT with every case Ive sent them. I think Odze is still there, no?

 

[Path_Anon]

i've heard good things from Mayo in terms of TAT. Hell, their whole setup is geared towards consults, with attendings there not called attendings but rather, "consultants." And each one has his/her own aa to help type reports, etc etc. Although you might not get the bigname you might be seeking on a case, if TAT's an issue I'd consider this option (unsure about their cost). Do keep in mind that Epsteinator's gotten so busy and now has so many fellows that he doesn't always look at all the cases.

And also be wary of other bigname programs out East (I'll refrain from naming them) where, as you alluded to, TAT totally blows. I've had many such experiences sending in cases for consults/2nd opinion, 5 days later I'll call to get an update (naturally, NO one called me to let me know if my case was even received -- as an aside, some places will send a quickie fax letting you know they've received it...a strong selling-point in my opinion!). Naturally, someone named LaShonda rudely answers the phone and seems annoyed that I've had the audacity to call about a case I sent in (and of course, the case has barely even been accessioned yet...even after allowing 3 days for transport delay).😕

 

[pathres2]

appelman and greenson at michigan fax you the report the afternoon of the day they receive the slides, unless they receive the slides after 4 pm!

 

[Absidia]

Do keep in mind that Epsteinator's gotten so busy and now has so many fellows that he doesn't always look at all the cases.

I can assure you that the only time Dr Epstein doesn't look at a case sent to him is if he is out of town. In that case, we have another GU expert (Dr Netto) who signs out the case.

 

[yaah]

The whole Barrett's dysplasia thing cracks me up. Experts can't agree on criteria for dysplasia. They disagree amongst themselves constantly. You call something low grade, send it to a group of experts. Depending on who is on consults, it could come back LG, HG, or indefinite. Yet the standard of care is to have barrett's dysplasia reviewed by an expert. Why? If experience helps with grading dysplasia in barrett's cases, why don't experts agree with each other?

As far as consults, I wouldn't necessarily limit yourself to a certain coast. The way things go these days, sometimes it takes longer to get something across the state than it does across the country. Mayo definitely has an efficient system. They have a system with fedex or UPS to specifically get consults delivered at a certain time of day. The biggest holdup with consult turnaround time is not usually with travel time TO the institution, it's with travel time WITHIN the institution. It may get delivered but be transferred from administrative assistant to administrative assistant, getting accessioned, catalogued, delivered to the right attending's secretary, etc. The last part can take all day!

 

[mcfaddens]

The whole Barrett's dysplasia thing cracks me up. Experts can't agree on criteria for dysplasia. They disagree amongst themselves constantly. You call something low grade, send it to a group of experts. Depending on who is on consults, it could come back LG, HG, or indefinite. Yet the standard of care is to have barrett's dysplasia reviewed by an expert. Why? If experience helps with grading dysplasia in barrett's cases, why don't experts agree with each other?

As far as consults, I wouldn't necessarily limit yourself to a certain coast. The way things go these days, sometimes it takes longer to get something across the state than it does across the country. Mayo definitely has an efficient system. They have a system with fedex or UPS to specifically get consults delivered at a certain time of day. The biggest holdup with consult turnaround time is not usually with travel time TO the institution, it's with travel time WITHIN the institution. It may get delivered but be transferred from administrative assistant to administrative assistant, getting accessioned, catalogued, delivered to the right attending's secretary, etc. The last part can take all day!

I agree completely I have no problem with laying down a diagnosis especially when Im 100% sure but I go by the books so Ill get another look when needed. Also I do not blame my pathologist college for any delay. I will always assume that there is some kind of external problem that would delay the case, but I found out today that this was not the case in my problem. I just dealt with a 1.5 week TAT and it took me 24+ hrs to get in touch with the "GI" pathologist (who's credentials pale in comparison to mine as far as "GI" is concerned and who used outdated/non standardized terminology on the report and I had to call 4 times just to get this person on the phone to clarify what the report stated) to just get a simple second signature. The case I refer to was an easy "cake consult" and all I got was a ridiculous comment section to the severity of the implications that the diagnosis rendered had on the patient with their particular disease at their age "really no ++++!! ". I made this attempt to send the consult (as simple as it was) to the nearest reputable university source as a sort of local trust, but was severely disappointed. Dude I was on the phone with the person today and I could feel the sort of "save my *****" or "well I just want to get this off of my desk" mentality which I do not expect from a consultant. PM me or post if you are or know from experience who or where to send some cases to and maybe I can find a solution to this problem.

 

[pathstudent]

I woould only recommend a community pathologist sending out the case if he is considering a dx of high grade dysplasia. Because if he calls it hg, the esophagus could very well be sitting on the cutting table in a few days. There is no reason to have IM reviewed if there is no dysplasia.

The good thing about sending it to the university is that even if academics might disagree among themselves. An academic can't be sued as it is impossible to claim an academic didn't live up to the standard of care as academics set the standard of care. So you really protect yourself by getting the academic seal of approval on your cases.

The whole Barrett's dysplasia thing cracks me up. Experts can't agree on criteria for dysplasia. They disagree amongst themselves constantly. You call something low grade, send it to a group of experts. Depending on who is on consults, it could come back LG, HG, or indefinite. Yet the standard of care is to have barrett's dysplasia reviewed by an expert. Why? If experience helps with grading dysplasia in barrett's cases, why don't experts agree with each other?

As far as consults, I wouldn't necessarily limit yourself to a certain coast. The way things go these days, sometimes it takes longer to get something across the state than it does across the country. Mayo definitely has an efficient system. They have a system with fedex or UPS to specifically get consults delivered at a certain time of day. The biggest holdup with consult turnaround time is not usually with travel time TO the institution, it's with travel time WITHIN the institution. It may get delivered but be transferred from administrative assistant to administrative assistant, getting accessioned, catalogued, delivered to the right attending's secretary, etc. The last part can take all day!

 

[yaah]

Um, what? Academics can't be sued because they set the standard of care? Are you serious? That might be one of the most bizarre statements I have ever read on here.

I agree that sending consults to academics in certain cases can reduce liability. Having multiple names on a report is always easier to defend if you turn out to be wrong. And having a big name on the report is also helpful. But that doesn't mean you can't get sued. And academics get sued too. It would be hard to win a lawsuit against someone for a pathology diagnosis where there is a lot of general disagreement (barrett's dysplasia), because the common knowledge in the literature is that there is major disagreement and irreproducibility.

 

[pathstudent]

You can sue one but it is almost impossible to prove an acadeic didn't live up to the standard of care as academics set the standard.

 

[Pingu]

I woould only recommend a community pathologist sending out the case if he is considering a dx of high grade dysplasia. Because if he calls it hg, the esophagus could very well be sitting on the cutting table in a few days.

This actually happened to me in my first two weeks as a "real" pathologist. I saw the hgd, showed it around my group, and sent it for an official consult as a cya. The day after I got the consult results back and signed out the final report, an esophagogastrectomy was sitting on the gross table. Even with everyone in agreement and the resection matching, it was a very sobering experience.

 

[2121115]

I just dealt with a 1.5 week TAT and it took me 24+ hrs to get in touch with the "GI" pathologist (who's credentials pale in comparison to mine as far as "GI" is concerned and who used outdated/non standardized terminology on the report and I had to call 4 times just to get this person on the phone to clarify what the report stated) to just get a simple second signature. The case I refer to was an easy "cake consult" and all I got was a ridiculous comment section to the severity of the implications that the diagnosis rendered had on the patient with their particular disease at their age "really no ++++!! ". I made this attempt to send the consult (as simple as it was) to the nearest reputable university source as a sort of local trust, but was severely disappointed. Dude I was on the phone with the person today and I could feel the sort of "save my *****" or "well I just want to get this off of my desk" mentality which I do not expect from a consultant.

Wait aren't these academics the "experts" that all community pathologists and patients revere as the most authoritative word? My, my. Well, at least they get the "joy of working with medical students and residents".

 

[mcfaddens]

You can sue one but it is almost impossible to prove an acadeic didn't live up to the standard of care as academics set the standard.

Listen Bro! "Pathstudent" Please read the initial post, I only want the opinion of practicing attendings. Please find another sandbox to play in.