How would you handle this situation

[bucknut101]

I saw a lady in clinic with visually significant Fuchs dystrophy back in April of last year and she was scheduled to have a DSEK procedure done by me later that month. She ended up cancelling and that was the last I hear from her until she showed up in my clinic yesterday.

Low and behold she had DSEKs done in both eyes and was returning to me to because she wasn't happy with the surgical result and also wanted a glasses RX. So I of course asked where she had had her DSEKs done and she said she ended up going to a a doctor in another city that was over an hour away. So of course I asked "well why did you do that?"

So apparently she had ended up seeing her family doctor after she had seen me and mentioned she was having a cornea transplant done by me. And so this family doctor, whom I've never met or even talked to, told her that she should go see this group of ophthalmologists in this other city to have the procdure done because "I've worked with them before and they will do a better job".

Needless to say I'm pissed. I've been in private practice for a year and half now and I'm still trying to build my practice. I'm a fellowship trained corneal surgeon that's done nearly 200 DSEKs and I'd like to think I'm pretty good at what I do. And I"m pretty sure that this family doc doesn't even have a clue on what Fuchs dystrophy or a DSEK even is. And it's ridiculous that the patient had to drive over an hour to have these procedures done when she could have stayed locally and had the same procedures done.

Would any of you confront this family doctor about what what he did? Would you write him a letter. Would you pay him a visit? A phone call. What would you say? Any advice would be appreciated. My current plan is to write him a letter saying that basically I'm a very well trained cornea specialist and that I really don't appreciate what he did.

Thanks

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[intoxicatedtiger]

First off, I think you should try to make certain that this family doctor did indeed tell the patient to go some place else. You know how patients can get their stories mixed up or even fabricate things.

If what the patient said is true, then I would personally call him and cordially give him a chance to explain himself. If he ends up being an ass about it, I would then unleash hell on this guy. Otherwise, I would approach it first as a potential misunderstanding. Who knows, if you're nice and polite about it, you might even gain a referral source out of him?

After a brief talk, if you think there's no chance of anything productive coming out of this conversation, do what you will. But keep in mind that if you piss him off, he can bad mouth you to other family practice colleagues, and you might even end up losing existing referral sources.

Personally, I wouldn't write a letter, which can leave a permanent trail.

 

[orbitsurgMD]

I saw a lady in clinic with visually significant Fuchs dystrophy back in April of last year and she was scheduled to have a DSEK procedure done by me later that month. She ended up cancelling and that was the last I hear from her until she showed up in my clinic yesterday.

Low and behold she had DSEKs done in both eyes and was returning to me to because she wasn't happy with the surgical result and also wanted a glasses RX. So I of course asked where she had had her DSEKs done and she said she ended up going to a a doctor in another city that was over an hour away. So of course I asked "well why did you do that?"

So apparently she had ended up seeing her family doctor after she had seen me and mentioned she was having a cornea transplant done by me. And so this family doctor, whom I've never met or even talked to, told her that she should go see this group of ophthalmologists in this other city to have the procdure done because "I've worked with them before and they will do a better job".

Needless to say I'm pissed. I've been in private practice for a year and half now and I'm still trying to build my practice. I'm a fellowship trained corneal surgeon that's done nearly 200 DSEKs and I'd like to think I'm pretty good at what I do. And I"m pretty sure that this family doc doesn't even have a clue on what Fuchs dystrophy or a DSEK even is. And it's ridiculous that the patient had to drive over an hour to have these procedures done when she could have stayed locally and had the same procedures done.

Would any of you confront this family doctor about what what he did? Would you write him a letter. Would you pay him a visit? A phone call. What would you say? Any advice would be appreciated. My current plan is to write him a letter saying that basically I'm a very well trained cornea specialist and that I really don't appreciate what he did.

Thanks

The "family" doctor did his patient a disservice by sending her elsewhere for care the quality of which care he was not qualified to judge, and for disparaging you by implying that you could not do as well for that patient as someone else.

I think you have a right to be angry with this family practice doctor. I would confront him privately and not in writing and tell him that his patient that he sent away from you behind your back to this other practice has returned unhappy with the results of her surgery done there. I also would tell him that you are both troubled with his actions and that you would like to tell the patient something other than the fact that he gave this lady poor advice, someone who evidently trusted his judgment, but that would not appear to be truthful.

It would be one thing if he had reason to send the patient to a practice he knew well, if they for example had asked him for a referral, but he did something very different by interfering with your relationship with that patient.

 

[J-Rad]

Look I'm in an entirely unrelated subspecialty, but, like you guys, plenty of people come to me on a referral basis. Frankly, I've been told so many bizarrely stupid things that were either just a *****ic grasp on what the PCP actually said or were just self-serving half truths-to-lies that I tend to give A LOT of benefit of the doubt to the primary. You really don't have anything to gain from "confronting him". If you're going to call (if that's something you typically do with this type of patient) then just tell him that she came back after not being pleased with her results from the other docs, what happened at the appointment, and what your plan for her is. Keep it light and non accusatory, and if you don't usually call, but you really want to call this guy, just say you're relatively new and want to reach out and get to know some of the PCPs. Don't be surprised if he says "I wonder why she went there" and "yeah, she's a little borderline...she likes her homeopathic proctologist more than me". If not, maybe then just, "thanks for the call". At least if you haven't made a friend, you haven't made an enemy. Similar strategy if you go the letter route: "Dear Dr. So And So, saw your patient Mrs. X after she returned to my care after not being pleased with her results at an outside facility. Blah, Blah. Thanks for this interesting patient. Please don't hesitate to call with any questions."

 

[Dusn]

What do you have to gain by telling the family practitioner how annoyed with him you are? It sounds like you're new to the area and you're trying to build a referral base. This family practitioner may eventually send his patients to you, considering you're closer. He also probably knows most of the other primary care doctors and specialists in the area. I think most primary care doctors consider referring their patients to specialists that they know and trust an important part of their role and will probably be pretty pissed if you tell them otherwise.

 

[orbitsurgMD]

I think what the family doctor did was interfering and hostile on its face. He knew exactly what he was doing and at least appeared indifferent to the consequences. It is wishful thinking to believe he will suddenly show some kind of willingness to refer locally, although I am sure he expected that whatever happened to this patient would be no worse that any surgery done anywhere else. I also suspect he might have imagined some perceived advantage in being able to "connect" his patient with the outside group, expecting the patient would be pleased. Well, I guess it didn't work out that way.

Assuming you are doing anything more for this post-op patient (are you?) a letter to both the family doctor and the surgeon who did the transplant bringing both up to date on the patient's progress and concerns and what you are doing for her would be in order. Don't make accusations, but you might at least mention in your letter that you came to know Mrs. X's case before her surgery and now that you have seen her post-op, a neutral recitation of the findings and your recommendations, with enough explanation to demonstrate your subspecialty knowledge of her post-op situation. This will of course bring things out in the open without making accusations, put the surgeon in the other town on notice that you are aware he took away your patient with the help of her family doctor and also let the family doctor know his intervention did not result in a happy patient, all the while you take the high road and do what you can for this lady.

It stinks having other doctors behave badly and un-collegially, and worse when they do so at patients' expense. Hopefully it won't happen to you again.

Good luck.

 

[guttata]

I wouldn't take it personally.

It is difficult, but we will all encounter similar situations.

I have had my share of 'lost' cataracts - a lot of it stemming from the fact that I look very young. At first I took offense. But, over time you realize that there must be a level of comfort, confidence, and trust between patient and physician. Every patient will not click with you - that's life - so what. In many fields, this relationship may not be important. But, in a surgical specialty, this relationship is very important. If the patient wants a second opinion on a cataract, I tell them "by all means, get a second opinion. After which, I hope you decide to have your surgery here. If you decide to have surgery elsewhere, I don't take any offense. You have to be comfortable with your surgeon." I have been on the receiving end of the second opinion trail - and in the end, it probably evens out.

First off, if you decide to approach the PCP, I would make 110% sure I had my facts correct. Patients may tell white lies, half-truths, etc. to save face. Unless the PCP is a complete jerk, I doubt he was disparaging your skills. Think about the other possibilities.

The patient may or may not have been comfortable with you. Or, from the PCP's perspective, he doesn't know you from any other Joe on the street, but he does know that this other group has good outcomes - based upon his years of referral to them.

In the end, it comes down to the patient's decision. Sure, it can be influenced, but ultimately, the patient decides. Also, if she wasn't happy with the surgical results, why did she have both eyes done there?

Any way you cut it, it sounds like the PCP does not know you well (or at all). I would personally meet with him (not just send a letter), introduce yourself. Tell him that you are highly trained in the exact same procedure. Tell him you are local, so that his patients won't have to travel far. Tell him you are available and accommodating.

Also, I would ask the patient to tell the PCP about her experience at the other practice as well as her experience at your practice. PCPs (or any other gateway providers) do NOT want to worry about their patients once they refer out. They want to know that their patients are in good and compassionate hands. If enough patients complain, the PCP may change his referral pattern. If this information comes directly from you, it will not have as much weight (and may come off in a "sour-grapes" way).

Hope this helps.

 

[Visionary]

I agree with most of the posters here. Don't rely on the paitent's "telephone game" in a situation like this. Too much chance for miscommunication. I would definitely call the family doc (letters, emails, etc. can turn out poorly), and in a non-accusatory way, relay exactly what the patient told you. Wait for the response, and take it from there. Again, try to be diplomatic. The doc may be a sleaze, but you don't know that yet. Heck, you may end up with another referral source.

 

[Pastrami King]

Every episode like this is actually a practice-building opportunity in disguise.

Patient was unhappy with her surgical care elsewhere? Make her happy. Kill her with kindness. Do that extra careful refraction. She'll tell her friends about you, and they'll come to see YOU. She'll tell her PCP that those other people screwed up but YOU made her happy (or at least were nice about it).

When you make her happy, tell her this: "If you think I've helped you, can you do me a favor? I'd like the opportunity to help a friend, a family member, or a coworker in the same way. If you know of someone who would benefit from my care, I'd be happy to see them." It sounds weird at first, but patients are really happy when you say this. Most patients think you are too busy- all they hear about is how busy doctors are, how they don't have time, how no one takes their insurance. They don't know you're just building your practice.They are touched that you'd offer to see someone they know.

"And so this family doctor, whom I've never met or even talked to, told her that she should go see this group of ophthalmologists in this other city." Exactly. He/she doesn't know you at all. So don't take it personally (unless it becomes a recurring issue). What a great way to introduce yourself. Definitely not in a ticked-off or accusatory way. And not in writing. But in a "Dr. Jones, I'm a cornea transplant and cataract surgeon down the block. I wanted to let you know I saw your patient Ms. Smith the other day after her corneal surgery done elsewhere. She wasn't thrilled with the result but together we decided to do the following: x,y,z and I'm going to see what I can do to improve her situation. I'd love to help out any of your patients who ever need second opinions or other ophthalmic consultations. Would you like some information on my practice, training, and medical interests?"

Nothing else will help the situation, help you build your practice, and increase revenue.

 

[davidjones]

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[DiveMD]

You have nothing to gain from confronting a random PCP in town. I would probably send him an introduction letter summarizing your training and your availability to take care of his patients. Maybe he’ll send you his patients in the future or not. But remember, he probably knows other primary care docs in town that can potentially refer to you. Don’t piss him off.

 

[bucknut101]

Thank you to everyone who gave their opinion. I talked to to the other docs in my group to see what I should do, since I am their employee and anything I do reflects on their practice. The concensus was to write a letter to the PCP and just say " Dear Dr so and so, I saw Mrs blank again after she went elswhere to have her corneal transplants done. She returned to me because she was not happy with the results, etc..... Basically a letter not accusing him of doing anything but just letting him know she's not happy with her care from the other doctor and that should get the message across to this PCP that I know what he did but without accusing him of it.

If I here anything back I'll let everyone know!