I hear you. I've found there's a list of things that all translate to one thing:
- Urgent consult
- IV antibiotics
- Stat (some king of imaging they don't have)
Translation - I don't know what to do and I don't want to be the last to touch this.
I really wish they would just call us and say something like "I think this patient might be sick and would appreciate your opinion" rather than lying about why they are sending the patient over, or relying on the patient to tell us everything.
Sometimes I get Urgent Care referrals because they want labs. And they call me prior. Like someone with a stupid chronic chest pain with non-specific EKG changes. Like TW flattening in the lateral precordium. One urgent care guy calls me from time to time and says "I would really like some labs for this low risk chest pain patient." Fine. (I'm not going to argue with him.) Then I ask "can you set up the patient for outpatient Cardiology or PCP follow-up? Since by the time I'm finished with the patient it will be 7:30 PM and doctor's offices are closed." He usually says "yes". I'm much more willing to help out in that case.
I had a PCP!!! send me a teenage girl for "r/o appendicitis". The pt went to the PCP earlier that day for an eval of crampy abdominal pain and diarrhea for 2 weeks after coming back from Africa. This was the second time at her PCP's office during that time.
I laughed out loud when the pt's father said she was concerned for appendicitis (I soon after apologized for laughing). I think I said something like "I think your PCP knows this isn't appendicitis."
It was clear after about 1 minute of history taking that she had some sort of infectious colitis from Africa. I got on the phone with my ID doc, he said immediately "I bet this is salmonella typhi." Send x, y, and z and start her on these two abx. Sure enough the salmonella Abs came back several days later as positive and the pt is now fine.
Just absurd. Why can't these PCP's call their fellow doctors sometimes? Maybe they do it more often than not.
Lastly, I made sure to thank the pt and her father for going to the PCP first, because that is the right thing to do in this case.