Interesting interaction with outpatient doc

[Sundance]

Our ophthalmologist just request an “embolic” workup rather than doing such work ups themselves. Guess I can see it going either way

[Eyemd356]

I also think ophthalmologists can otften feel marginalized by their fellow physicians-I suppose this kind of behavior doesn’t help our cause.

As always, communication via a phone call or letter is always a good idea

[Dusn]

What was the diagnosis that led to the workup?

[wideopenspaces]

Every once in a while I need an ekg for meds that can cause qt prolongation. I've always asked the pcp to order it. I'm not going to pretend I can read an EKG anymore. Plus I have never worked in a psych clinic that had an EKG machine. Not sure if this is the same thing as in OPs case? But I do order my own labs . . .

[kayli69]

I am a specialist and I see this all the time when my pts go see a MD turned Holistic/Herbalist. They come back with a laundry list of bizarre, rarely ordered, difficult to interpret tests that the Herbalist requests I order I always tell then the person is an MD and if they want these tests ordered they can order them and interpret them

[CordMcNally]

I am a specialist and I see this all the time when my pts go see a MD turned Holistic/Herbalist. They come back with a laundry list of bizarre, rarely ordered, difficult to interpret tests that the Herbalist requests I order I always tell then the person is an MD and if they want these tests ordered they can order them and interpret them

Impossible to interpret tests are the backbone for these practices. This way they can pretend to give the patient an answer that is basically impossible to disprove and the patient latches on to it and basically thinks all the physicians they've seen previously are idiots and just didn't care enough to actually diagnose them.

[Savedfpdoc]

Im Family med, I’m in a rural area, this happens frequently from Specialists. Doesn’t bug me, I see anyone who walks in the door. I’m paid on productivity. Don’t judge me

[Lordosis]

Im Family med, I’m in a rural area, this happens frequently from Specialists. Doesn’t bug me, I see anyone who walks in the door. I’m paid on productivity. Don’t judge me

If you make the patient come in to see you then yes it's win-win for you and the specialist but it is an extra burden to the patient. I'm not judging you and I would probably do the same thing if I was in that situation but somebody has to pay. I think the situation being described as the specialist wants the PCP to order the test and deal with the headache of getting it approved or through a prior authorization and then interpret it and deal with the results for free.

[MPMD]

to play devil's advocate the specialist might imagine or guess that the kind tests an embolic workup would require might be useful in other contexts.

i would think this would be far more annoying if it was something like an MRV of the cavernous sinus.

it could be laziness, or it could be that the ophtho is assuming that the PMD might want the carotid dopplers to give to cards etc.

that said, i have a ton of respect for PCPs but i think those of us who are not in primary care vastly overestimate the average primary care doctor's bandwidth (let alone interest) for coordinating care across multiple specialties.

[CM]

Every once in a while I need an ekg for meds that can cause qt prolongation. I've always asked the pcp to order it. I'm not going to pretend I can read an EKG anymore. Plus I have never worked in a psych clinic that had an EKG machine. Not sure if this is the same thing as in OPs case? But I do order my own labs . . .

You don't have to interpret an ECG to order one. A cardiologist will interpret the ECG you order.

I order chest CTs that I don't interpret. That's for the radiologist to do.

[CM]

As a purely inpatient doc, i dont always know how things work on the "outside".

My father went to an ophthalmologist(not optometrist) who recommended a battery of imaging studies of the brain, carotids, echo etc. He then proceeds to tell him to get these ordered by his primary doc. Aren't optho's MDs? Cant they order all these imaging studies? Is this how outpatient works?

It just seemed odd that this doctor referred to another doctor to do order the tests.

A patient came to me and said that his orthopedist needed me to order a vascular study before the orthopedist would operate. What the ?

[Anne]

I am a specialist and I see this all the time when my pts go see a MD turned Holistic/Herbalist. They come back with a laundry list of bizarre, rarely ordered, difficult to interpret tests that the Herbalist requests I order I always tell then the person is an MD and if they want these tests ordered they can order them and interpret them

i remember hearing a case at a conference where the pcp didn’t say no to this crap and got talked into ordering some genetic testing (I think mthfr was one of the tests uggh)…and then later on the patient got cancer and someone went back and looked at the testing and found it showed some mutation that predisposed to the cancer…it wasn’t brca or anything like that…something much more esoteric and thus not recognized by the pcp…anyways the story was that the pcp was sued and lost the case. May have been a tall tale but all I need to be able to say no

[wideopenspaces]

You don't have to interpret an ECG to order one. A cardiologist will interpret the ECG you order.

I order chest CTs that I don't interpret. That's for the radiologist to do.

Good point! But if I ordered an ekg I don't even know where the pt would get it. I guess it's more of a logistical issue than anything else.

[Notsobad]

Definitely a problem, combination of passing the buck, the specialist not straying from his core business, and not straying from his expertise. But the patient is left hanging and the PCPs may have to generate more referrals if they don’t feel comfortable with the work up.

on the flip side, some HMOs make ordering anything torture, and everything has to be approved and sometimes reordered by the PCP (sometimes not properly)

[TheDangerZone]

As a purely inpatient doc, i dont always know how things work on the "outside".

My father went to an ophthalmologist(not optometrist) who recommended a battery of imaging studies of the brain, carotids, echo etc. He then proceeds to tell him to get these ordered by his primary doc. Aren't optho's MDs? Cant they order all these imaging studies? Is this how outpatient works?

It just seemed odd that this doctor referred to another doctor to do order the tests.

Can you clarify what the diagnosis was or what the concern was? Sounds like a non-urgent embolic workup. If there was an embolus or amaurosis, then your father would probably have been sent to the local ED for an urgent val.

Also, did the ophthalmologist refer your father to the PCP or did they say to tell your PCP to order the tests without seeing him?

Interesting that a lot of people here are assuming it's laziness or that his Ophthalmologist doesn't care. Would we all expect Ortho to do an outpatient stroke workup?