PCP pet peeves

Ask any primary care clinician for a list of pet peeves and one of the top three will be: “Doing my consultant’s work.”

Just to be clear, the overwhelming majority of specialist consultants DON’T do this. But some do it occasionally and a few do it as a matter of routine. Every time it happens, it rankles.

A few examples:

• I’ve referred the patient to the neurologist for evaluation of right upper extremity paresthesias after my initial evaluation is unrevealing. The neurologist does some additional lab, an MRI, and nerve conduction studies. Three weeks later the patient is in my office, upset at not having heard results. We call the neurologist’s office and learn that the results are back, suggesting a compression neuropathy at the elbow, and that the neurologist has dictated but not yet signed a letter to me explaining this and suggesting that I refer the patient for decompression surgery
• My patient is seeing a bariatric surgeon about a surgical weight loss procedure. during the evaluation, she is found to have a low Vitamin D level. She calls my office when she gets a call from the nurse in the bariatric program telling her to call her PCP to talk about treating her low Vitamin D level.
• My patient is admitted to the hospital with a crush injury to her foot that requires amputation of several toes, and a small skin graft. She is sent home (where she lives alone) and told to stay off her feet and do daily dressing changes. When she calls the surgeons office to find out about crutches and home health for the dressing changes, she is told to contact her PCP to arrange this.
• My patient is seen by the gastroenterologist to evaluate abdominal pain. During the evaluation, an abdominal-pelvic CT scan shows a small nodule in the lower lobe of the right lung. The gastroenterologist has his staff notify my staff that the CT shows a pulmonary nodule and asks me to contact the patient about it.
• The otolaryngologist sees the patient for me about chronic hoarseness and confirms my suspicion that this is related to post nasal drip. He suggests a couple medications and gives samples with instructions to call in two weeks if they help.  They help a great deal, so he gives her a prescription. It turns out they are not on the patient’s insurance formulary, so they require filling out forms for a prior authorization, which he tells the patient to have the PCP do. 

As a rule, consultants are conscientious and work hard at tying up any loose ends. Episodes like this are uncommon, but they cause distress out of proportion to their frequency.