Family medicine MD/DO will be obsolete?

[K82]

My hats off to you for coming in but if it’s so emergent the hospitalist should just go ahead and treat (insert comment about messing up the cultures). I know for a fact our IR people won’t come in and I’d never ask them to. If the LP truly needs to be done emergently it’ll get done in the ED. All others (almost all of them) can wait.

You are one of the great ER docs out there. Not all are of your caliber!

[K82]

Your doing the procedure in the radiology department is like my doing a bone marrow in my office. My tech knows how I like it, has it set up and it takes me 20-30 mins of being in the room.

Doing that on the floor - to put it mildly, it is like working in a zoo. Nothing is ever there, no nurse to assist, no lidocaine or ativan, not sufficient slides inside tray or appropriate tubes and so on and on. After a few attempts of doing this nonsense routine the doc gives up and sends to IR. After a year or two he gets rusty and does not know how to do it well.

My last LP to inject intrathecal methotrexate was about 6 years ago. That was a near disaster from getting sterile preservative free MTX to the appropriate kit to having a nurse to assist me having the patient in the appropriate position. I have given up after that. I can still do LP and central lines but it is not worth the time or money.

I can see how that would be and I appreciate your point. I assumed that the Hospitalists would have the same support staff on the floor similar to what I have in my dept. I'm sure that's not always the case.

At some of the smaller hospitals we cover where the techs don't do much in the way of procedures it can devolve into a goat rodeo. Those LPs may take me 20 minutes! ( tech: I thought we had 22G spinal needles down here....I go find one...)

[CordMcNally]

You are one of the great ER docs out there. Not all are of your caliber!

I don’t think that’s true but I think it’s more of physicians clinging to old mantras and ways of practicing medicine.