Private practive PM-Call or no Call

[schmee90]

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I am in a job were we have no inhouse call. We do procs at a surgery center start early finish around 2. Our clinic is open until 6 pm, and surgery center has RNs who call patien next day. I knock on wood have never had a major complication such as a epidural hematoma, infection, etc. All cervical ESI are scheduled before noon.

I do mostly bread and butter procs and SCS trials. There is discussion on wheter we need to be on call for after hours due to an emergency primarily related to procedures.

What are other peoples practices like in terms of call vs no call? Is there an added liablity with our group not having after hour call that you can respond to.

 

[willabeast]

It depends on how good the people who the patient contacts post procedure are at dealing with post procedure issues. When I was practicing a PMR group took call for everything (and were paid to do it). In over 20 years there was one problem they failed to pick up on. A cervical epidural abscess in a diabetic with renal insufficiency after I did a cervical epidural with a catheter. I don't know why the on call doc missed the diagnosis but the patient was smart enough to contact me and I figured it out pretty quickly over the phone. There was no litigation that I am aware of. I do think the doc doing the procedure is the best person to diagnose post procedure issues but I do not think it is strictly necessary if you have a well educated E.R. to at least triage stuff that can wait until next morning, but good enough is not always best.

 

[schmee90]

It depends on how good the people who the patient contacts post procedure are at dealing with post procedure issues. When I was practicing a PMR group took call for everything (and were paid to do it). In over 20 years there was one problem they failed to pick up on. A cervical epidural abscess in a diabetic with renal insufficiency after I did a cervical epidural with a catheter. I don't know why the on call doc missed the diagnosis but the patient was smart enough to contact me and I figured it out pretty quickly over the phone. There was no litigation that I am aware of. I do think the doc doing the procedure is the best person to diagnose post procedure issues but I do not think it is strictly necessary if you have a well educated E.R. to at least triage stuff that can wait until next morning, but good enough is not always best.

Interesting...Do you mind me asking what the symptoms where that an on call doc said wait, and you said no you need to go to the ER? Also how did the patent get ahold of you after hours?

I am just thining if this is gonna be a big headache with other peoples patients. I take a lot of time talking to patient on what to expect risks benfit etcs, give them a handout which i review....my colleagues, or at least one of them says we are seeting you up for an injection for your pinches nerve my ma will help you. Not much anticipatory stuff..ie am i gonna get blasted with all his patients asking why their RFA hasnt started working in the night of the inejction

 

[mille125]

In my state you have to have a way that patient's can reach out per insurance contracts.

If you are doing any procedure but especially SCS trials, there has to be a way that patients can call you if there is an issue. Someone has to take these calls even if it is an answering service forwarding messages to you. You don't want to hear about these things the next day.

Having no one taking these calls really is not proper. You need to talk to your group.