Polite Dissent

As a Family Practice physician, the physicians I interact with the most are the doctors from the local Emergency Department. We have a good hospital and an excellent emergency department, and I trust every physician there. Still, there are some things that frustrate me as a primary care physician. With that in mind, here are my recommendations to make a good Emergency Department physician a great Emergency Department physician.

Cut to the chase — Start out by telling me the most important thing: the disposition of my patient. Tell me right off if you are calling about an admission, a follow-up, or just to ask questions. Don’t try and tack it on in the end with an “Oh, by the way, I’d like to admit this patient…” You’re not fooling anyone.

Be concise — Sum up why the patient came in, what you did in the emergency department, and what your plan is. Include pertinent positives and negatives but please don’t tell me the patient’s entire life history. I’ve probably already heard it time and time again and I’ll undoubtedly forget the important parts before you’re finished.

Get appropriate labs — The main problem I see in this area is blood cultures. If a patient is being admitted for an infection, they need blood cultures. The best place to obtain this is in the emergency department before any antibiotics have been given. (This goes for urine cultures too.) If you’re convinced the patient has a heart condition or pancreatitis, prove it to me with the appropriate labs, don’t just assume and admit because it puts me behind the eight ball.

No politics — I know you don’t get along with that other doctor, but please don’t involve me in the situation.

No agendas — There was an emergency department physician I once worked with who felt that the hospital needed better inpatient cardiac facilities (and he was probably right). To prove his point, he tried to admit every single chest pain patient that set foot in the emergency department. Don’t make me and my patients hostages of your agendas.

Careful with Follow-Ups –I appreciate it when the emergency department arranges appropriate follow-up appointments for my patients with specialists such as surgery or orthopedics. However, please make sure these physicians are actually accepting follow-ups. I’ve had a number of patients in my office who were told to follow-up with a particular orthopedist despite the fact that he hasn’t been taking new patients in over a year. Some insurance companies require primary care physicians to sign off on all consults. If this is the case, I will need to see the patient myself because I don’t sign anything without evaluating the patient for myself (it’s not that I doubt your skills, but it’s my name on the line).

Timely Reports — For patients who are following up with me, it is extremely helpful to have their emergency department report — along with labs and radiology results — in hand for their appointment. So please write neatly and make every effort to get these to me in a timely manner.

Specialists are not always necessary — Don’t suggest that patients need specialists for the care of routine problems. Not all ingrown toenail require podiatrists; most hypertensive patients can be handled in primary care clinics. This is one of my pet peeves. I don’t undermine your medical care of the patients, please don’t undermine mine.

Tests – Don’t promise patients tests or studies that may not be necessary. At least once a week I see patients in my office who tell me that the emergency room doctor told them that they needed an MRI (or some obscure blood test). Sometimes they do; usually they don’t. Certainly some of these patients may have misunderstood what they heard or have their own agendas, but when it’s always patients of the same emergency room doctor, I get frustrated.

Report status changes – If something happens between the time we talk and the time the patient gets admitted to the floor, please update me. If the patient goes to a different floor than we planned or leaves AMA, please let me know. I don’t have the time to waste searching the hospital for my patient the next morning.