Jul 17, 2009
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All consults are worth your time if you get paid to work. Perspectives change radically once residency is over! But we all have our pet peeves. Mine was being consulted for admission to the TBI unit for " cognitive deficits and gait disorder" in the highly intoxicated now going through withdrawal after some short stay elective procedure (like a TKA). My consult would predict a radical and almost miraculous return to full cognitive function in 3-5 days and no need for acute TBI rehab placement.
 

Ludicolo

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Got one consult recently where the indication read: "please determine if we should consult ortho".
 

PMR 4 MSK

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"Placement options" - no, that's why we have social services, not what PM&R does.

"Consult PM&R" on the first line.
"Transfer to PM&R service" on the second.
Neurosurg did this all the time.

Post-residency, I used to get pts admitted for TKA and rehab consult the same day. Many would go home in 2-3 days.
 
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cartoondoc

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Got one consult recently where the indication read: "please determine if we should consult ortho".
That is really really funny. Can you imagine if an orthopod got a consult that said: "please determine if we should consult pm&r"? Someone would get fired.
 

Brooklyndo2.1

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i dont know if this is funny but more annoyihng : 102 yaer old S/P syncope eval for dispo" please note patient already had a DICSHARGE ORDER
 

fozzy40

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i dont know if this is funny but more annoyihng : 102 yaer old S/P syncope eval for dispo" please note patient already had a DICSHARGE ORDER
Unfortunately, it's pretty common.

Is there much education to the inpatient services about what is an appropriate PM&R consult? I know this is something that we have been struggling with for years at my institution.
 

PMR 4 MSK

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Unfortunately, it's pretty common.

Is there much education to the inpatient services about what is an appropriate PM&R consult? I know this is something that we have been struggling with for years at my institution.
It's a mentality more than a slight to PM&R. Residents and many attending want people off their services as quickly as possible, so they'll look for any way to D/C or tranfer. I've found the major reason PM&R is consulted much of the time is at the suggestion of social services or sometimes nursing. Once you take the patient, they quickly forget about you. Usually.

I remember needing a cardiology consult as a resident, so I called the resident with the cards beeper. I told him about the patient and he asked "where is the patient?" I said "On rehab."

He paused for a second, then "Uh, where is that?" "5 M" I told him. "Hmm, where's that?" So I gave him directions. After the consult he asked what we did on rehab, so I gave him the mini "What is PM&R?" talk. He had no idea the field even existed.

When I said we treated deconditioned patients, a light bulb went off. Over the next few weeks, we had countless consults from cardiology. He musta gone off rotation then, as the consults from cards went way down.
 

fozzy40

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I realize that the "Rehab Dump" is a common practice in the country. Unfortunately, it always comes down to how many beds are available and if/what insurance they carry which always trumps the "appropriateness." So in a way, the transferring resident there is no disincentive or repercussion for a "bad consult." In fact, they get rewarded for getting rid of the patient without knowing how they did it.

However, if we are going to complain that no one knows what we do then we should try to do something to force people to think before they hit "sign." At my institution, the PM&R consult order has an open text box for "reason" so you could put anything in there and the order will still go through. I would like to change the open box to a drop down menu with rehab appropriate reasons for consult (gait instability, tetraparesis/paraparesis, hemiplegia, etc) which they have to answer in order to execute the order. I hate when I get "weakness" or "deconditioned" as a reason. I once asked the ordering resident why that was a concern since everyone in the hospital is "weak" or "deconditioned." It could be a small yet annoyingly passive way for them to learn a little something about what we do.

Just a thought...
 

Ludicolo

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I realize that the "Rehab Dump" is a common practice in the country. Unfortunately, it always comes down to how many beds are available and if/what insurance they carry which always trumps the "appropriateness." So in a way, the transferring resident there is no disincentive or repercussion for a "bad consult." In fact, they get rewarded for getting rid of the patient without knowing how they did it.
House of God. Rule #5. Placement comes first.

However, if we are going to complain that no one knows what we do then we should try to do something to force people to think before they hit "sign." At my institution, the PM&R consult order has an open text box for "reason" so you could put anything in there and the order will still go through. I would like to change the open box to a drop down menu with rehab appropriate reasons for consult (gait instability, tetraparesis/paraparesis, hemiplegia, etc) which they have to answer in order to execute the order. I hate when I get "weakness" or "deconditioned" as a reason. I once asked the ordering resident why that was a concern since everyone in the hospital is "weak" or "deconditioned." It could be a small yet annoyingly passive way for them to learn a little something about what we do.
Drop down boxes and check lists don’t stimulate thinking. Rather the opposite. Every consult you’ll get will then carry an indication of “gait instability”, or whatever the first choice is.

This is a pain at first, but initially I have my residents call back the ordering service on almost every consult in order to confirm the reason (and the appropriateness). Half the time the reason from the intern is “because my senior or attending told me to”. Then the PM&R resident goes into the spiel we all know and love.
 

RUOkie

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Once you are in the real world, it continues to be annoying, but less so.

I have a nephrologist who thinks I walk on water. He sends me patients to my office and consults me in acute care and LTAC. The reason is ALWAYS the same--"Debility". 9/10 times I figure out why the person is having trouble, and he is happy. When I see that he is the consulting doc, I inwardly groan, but outwardly smile. He is ensuring that I remain busy. That pays bills.
 

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I will once again point to the consult we recently got for "phodiatry".