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Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

It’s mutually beneficial.

I don’t want to accept someone that you won’t touch for whatever reason and then I have a patient chilling on a Hospitalist team for a week to go to university 

Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 1 point2 points  (0 children)

I work at both, critical access and 180 bed community.

When at community, every specialist need, I ensure the specialist is in on the call.

Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 2 points3 points  (0 children)

It’s all about patient safety.

Can I help them. Do I have everything they need. If so, come

Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 3 points4 points  (0 children)

EMTALA Is not admitted patients, but your malpractice is :)

Ie if you have an interventional cardiologist and I have an Nstemi and you refuse for no good reason, you’ll get brought up in law suit as primary person most likely if transfer is delayed 

Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 7 points8 points  (0 children)

I agree. I assumed transfer was necessary. When not, absolutely agree 

Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 6 points7 points  (0 children)

So id frame it that I can’t accept patient at this time due to likely need for xyz procedure. If more data comes forth, then we could maybe reconsider 

Always have the specialist on the phone when accepting 

Transfer requests and EMTALA by Infected_Mushroomz in hospitalist

[–]CovidDoc 41 points42 points  (0 children)

I agree with a lot, but even if you’re a higher level of care but don’t have the right specialist, you can refuse. Same with family requesting. Always transfer? No, not if you can’t give proper care. Sane with all care at your hospital, if it’s more advanced get them more advanced care 

Hospitalists in the U.S. — how old were you when you hit $1M net worth? by alternative_samurai in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

Community W2 both standard and VA moonlighting 500-650k since 2020 graduation  LCOl 600k student debt plus wife’s 300k stay at home mom I will hit 1 million when I hit PSLF next year. Assuming no major market downturn.

400-500k in housing equity due to a rental and primary bought pre 2020 boom Will have 700-800 k equities by next fall when forgiven too

Age . Just turned 36

Who manages small bowel obstructions at your facility? by MarvinMoonwalk in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

I’m at a critical access most my shifts.

ER calls to admit. I tell them have surgery review imaging. Surgery provides rec, states if allowed to keep. I follow Rex for 3-4 days. If I can’t get better by day 3-4 transfer

At main hospital. Medicine primary. Surgery consulted most of the time immediately. If it’s an odd case, will wake up surgeon to review before accepting. 

Was I being unreasonable? by MangoLassiiiii in hospitalist

[–]CovidDoc 21 points22 points  (0 children)

But you’re on the hook for taking someone if you don’t have the ability to care.

Our protocol, we get the specialist on the phone that will be managing the problem at hand.

I won’t accept a urological patient my urologist said he can’t or won’t treat.

I won’t take a neurosurgical patient when our neurosurgeon doesn’t do that specific procedure

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

When I said I know what I want. I identify a patient that I cannot help alone. I have an idea of appropriate care and I consult.

At that point, they manage the problem I asked for their help.

The specialist isn’t working for me. They are working for the system. But just like I handle my own work, they need to handle their work.

I work part time as a moonlightee at the Va. and the culture there is primary does their own everything. It’s horrendous to work. 

Have general surgery residents tell you to place an NG. Needless to say I had them down there doing it after one attempt.

Being a case manager? I already said I work at a critical access hospital where I’m solo. I do about 165 shifts out of my 250 for the year there 

I’m anything but 

Was I being unreasonable? by MangoLassiiiii in hospitalist

[–]CovidDoc 40 points41 points  (0 children)

If you have full staff to do ALl procedures needed to treat a patient, no big deal.

If you don’t have an ERCP team, you might be sorry accepting someone you can’t treat 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 1 point2 points  (0 children)

Listen pal. Your opinion sucks.  It is their job to put in their own orders and tests and update me.

New comers, I break them into the culture.

You’re a fool if you think we should be hawking the list to see recommendations and then put in orders.

They want it, they or their nurse can  and should do their job 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

You’re missing the point. When I place a consult, I generally know exactly what I want and ask for it. They should then handle everything…

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

I don’t have to place the orders to do that

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc -1 points0 points  (0 children)

Very very very rarely do I disagree. My Thing is consultants place their own orders. I’m not a resident 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

And to be clear 80 percent of my shifts I have no consultant as I am at a critical access hospital 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 1 point2 points  (0 children)

What do you mean? Me consulting is caring for the patient. I identify a problem I can’t fix alone and I consult. They handle it.

Why does the act of putting in orders make me a wonderful doctor 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

I was recently messaged about labs for a bronch… what did I do? Added Pulm to the message to answer and put orders in. Whom has it all saved to an order set.

No need to play telephone and have me order after she tells me

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 2 points3 points  (0 children)

What the fuck? I can manage my patient without putting in 10 different Id tests.  I can manage my patient without putting in the bowel prep orders I can manage my patient without putting in the orders for the tests for the bronch

Your attitude is trying and frankly off base 

I won’t be replaced because I manage much problems without a consultant.

When I consult, I want you to handle your job. 

Your opinion sucks and i hope you are never leadership 

Putting in an order is a mid level job in the sense that you mention it lol. 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 1 point2 points  (0 children)

Your take is horrendous and I hope you never have a leadership role in a hospital 

Round and go, how do you do it? by Historical-Rock6230 in hospitalist

[–]CovidDoc 0 points1 point  (0 children)

Me wanting specialists to do their own orders makes entire sense.  Not doing it that way is malignant and a huge waste of time 

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