Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, June 01, 2009

More Disrespect

I know, I know; I should consider myself lucky just to get letters from specialists when I refer patients to them without being so picky about what those letters actually say. Still, it's the little omissions in their letters that add up to the persistent, niggling disrespect for family medicine that really pisses me off.

I saw an older lady who stepped into a hole (covered with grass; it wasn't her fault), fell about two feet straight down, and hurt her ankle. I asked her to come into the office where I took a history and examined her. Based on my evaluation, I diagnosed a fracture of the distal fibula and sent her for confirmatory x-rays. As it happens, my patient demographic expects an automatic orthopedic referral for any and all fractures, so the positive x-ray prompted the referral.

Today I got the letter about her visit.

In it, the orthopedist duly repeats the history he obtained from the patient. (I suppose I should consider myself particularly lucky in that it was the same as the history I obtained) followed by this line:
She called her PCP, who ordered x-rays and referred her here.
[Great gnashing of saurian jaws]

Wait one dang-blasted minute! Talk about omitting pertinent details!! In order to be accurate, that note should have read
She called her PCP, who saw her in the office, examined her, diagnosed a distal fibular fracture and ordered confirmatory x-rays, and referred her here.
Remember, if it isn't documented, it wasn't done. So as far as anyone in this orthopedic office is concerned, they were the ones who diagnosed the fracture. I'm sure there are those who will accuse me of making a mountain out of a molehill, but I don't think so. These little slights may seem insignificant in and of themselves, but over time they result in a gradual wearing away of the esteem in which family medicine is held by other doctors.

And that pisses me off.


At Mon Jun 01, 09:50:00 PM, Anonymous Anonymous said...

That's just the way it goes. PCP's do the triage and the specialists get the work done. At least that's what they think.

At Mon Jun 01, 10:08:00 PM, Anonymous mamadoc said...

Yeah, I know. Happens all the time. Triage, schmiage.

At Tue Jun 02, 12:04:00 AM, Anonymous Anonymous said...

"Remember, if it isn't documented, it wasn't done."

Dude. That saying applies to YOUR documentation. If someone else doesn't document something you did... so? The guy was probably hammering out ten dictations at the end of the day on autopilot.

I think the real slights may have accumulated to the point where you now are looking for things to interpret as insulting.

At Tue Jun 02, 02:07:00 AM, Blogger TDB said...

Don't worry some of us still are going to go into family medicine.

At Wed Jun 03, 01:04:00 AM, Blogger Toni Brayer, MD said...

I understand feeling slighted by little things. An ortho guy once dictated in his note that "attempts to contact (me) were unsuccessful because it was after 6:00 PM". Since I was in the office slaving away until the wee hours every single night I was enraged by this comment on the consult note. In fact my car was usually the last one in the lot...long after the specialists went home. This was 20 years ago and it still smarts!

Like you, I rarely refer to get the diagnosis made. I do the workup and differential and diagnosis myself and refer for specific reasons. Touche'

At Wed Jun 03, 06:52:00 PM, Anonymous tom said...

Detailed ortho note
"It was broke.I fixed it."

At Tue Jun 23, 09:44:00 PM, Anonymous red rabbit said...

Well, you may not be that sort of family doc, but not everyone is as good. The ortho note would have been accurate for some.

Not slagging off family docs, I am one. Just saying what I see.


Post a Comment

<< Home