Comments on: A surgeon dumps post-op patients to hospitalists

By: peter oconnor md

peter oconnor md — Wed, 10 Jun 2009 16:32:25 +0000

our pediatric practice no longer rounds on newborns, they are seen by NNP’s (who are contracted by us). Are we obligated to see healthy newborns for followup whose insurance plans we don’t accept. Is it an EMTALA violation to tell them when they call to schedule a followup that they should seek another provider in plan or they will get billed by us?

By: BoneDoc

BoneDoc — Sun, 07 Jun 2009 12:22:52 +0000

I certainly do not “dump” my post op patients to any hospitalist/specialist other than myself. If patients do have other medical conditions to be taken care upon by specialist other than me, he/she is simply being co-managed and not dumped to some hospitalist. I take pride in seeing my patients pre and post op and after they are well into a functional member of a community even if they are being treated for other chronic medical conditions.

By: Dr. Kranky

Dr. Kranky — Sat, 06 Jun 2009 17:18:29 +0000

a) You must keep the distinction clear between orthopods and surgeons.
b) I assume Dr. Hospitalist is NOT griping about having to take care of a patient’s MEDICAL problems.
C) An orthopod who sees a post surgical patient on the day of discharge only is a malpractice lawyer’s wet dream

By: Doc Stone

Doc Stone — Sat, 06 Jun 2009 14:49:08 +0000

Another point: Why don’t the hospitalists just refuse to participate in this if they don’t think it is adequate? “No” is a powerful and often necessary word in medical practice. If they participate then they are agreeing that it is in fact adequate and appropriate and have no complaint.

By: Doc Stone

Doc Stone — Sat, 06 Jun 2009 14:45:47 +0000

This is basically a form of soft billing fraud. The surgeons get so much more for a 1 hour surgery than an internist gets for a 1 hour consultation in part because the fee is to pay for the post-op care. I am not a surgeon but the ones I trained with many years ago I think would have been ashamed of this and considered taking ownership of the responsibility core to their ethic as surgeons. Certainly they need the consultation of the hospitalist but I agree that this is, by traditional standards, a mild form of abandonment.

It is not unique however and just another example of the ongoing process of deprofessionalisation of medicine predicted by the opponents of medicare and the economist/social philosopher Frederick Hayek as the eventual inevitable consequence of government control.

By: Anonymous

Anonymous — Fri, 05 Jun 2009 20:33:56 +0000

If surgeons do not want the extra work, then medicine doctors should welcome it. They should just be compensated at the same level as surgeons are for preforming the procedure, because the surgeons need the medicine docs to cure the patient.

By: Matthew Bowdish

Matthew Bowdish — Fri, 05 Jun 2009 20:11:26 +0000

I would beg to differ with A Surgeon. Where I attended medical school, the surgeons took great pride in being able to fully treat almost all of their patients from admit to discharge. I learned more about the parathyroid & calcium metabolism from surgeons than I ever did from internists. And some of my best intensivist training came from surgeons. I don’t know what’s worse; the fact that surgeons don’t want to assume this role, or that they are hindered from doing so by bad govt insurance mandates. Either way, patients lose when talented professionals like my surgical mentors go the way of the dinosaur.

By: jenga

jenga — Fri, 05 Jun 2009 18:13:53 +0000

http://www.ncbi.nlm.nih.gov/pubmed/15824300?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Hospitalists are a victim of their own success their is no reason that they shouldn’t be consulted on every elderly hip fracture. It is after all about what’s best for the patient.

That may be the only arrangement in which they will still take call. The hospital I trained at Orthopedics was a consult only service.

By: Kevin

Kevin — Fri, 05 Jun 2009 17:17:00 +0000

There is no reason why the surgeon shouldn’t remain the primary physician in post-op cases, with a hospitalist in a consultation role.

Kevin

By: A surgeon

A surgeon — Fri, 05 Jun 2009 16:08:23 +0000

This is not dumping-this is good patient care. Most of these hip fracture patients are from the nursing home and have multiple chronic medical problems that need to be managed by internal medicine.