“I can do that?”
During a recent morning practice session, a resident presented a patient who had several episodes of syncope, which culminated in a trip to the emergency room. To evaluate this problem, we decided to start with a new EKG and a Holter monitor to see if she might have any significant arrhythmias contributing to her symptoms.
Interestingly, that is when the intern said, “So I’ll refer her to cardiology for that.”
I asked him why he thought we needed to send the patient to cardiology for an arrhythmia monitor, and he replied that since this was a cardiology problem we were evaluating she should see a cardiologist. I told him that this was well within the range of something we can handle, both in the evaluation and possibly even the management of this patient.
Each provider has a threshold, the level at which we decide we’re comfortable taking care of the condition, and when we’ve decided to go no further. Sometimes I need some help, some consultation, and some reassurance that I’m providing the appropriate standard of care.
But it seems that we’re not doing enough when it comes to returning care to the primary care doctor. Our specialists and subspecialists seem overwhelmed with ongoing management of patients they have been asked to see for a consultation and have limited availability when we need them to see someone acutely.
As we change the healthcare system, we want to change things to return to us so we practice up to our license (and no further). Give us the resources, infrastructure, equipment, and time, and we will do skin biopsies. We will drain joints and do bedside ultrasounds. We will extend our skills into areas that are currently being sent out for consultation.
As we move our practice back to a more patient-centered model and continue to evolve healthcare in the 21st-century, we need to think what we can capture back, provide services for patients without making them wait such a long time to get answers.
Then we can say, “We can do that.”
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Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine. Pelzman’s Picks is a compilation of links to blogs, articles, tweets, journal studies, opinion pieces, and news briefs related to primary care that caught his eye.