work and pay

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annie, BE TOUGH-- REQUIRE a good working relationship with EVERYONE, patients and specialists, like joanne says. end relationships that don't work out. require patients to be seen, you are responsible for what you prescribe. be well-versed in what you know and do, like lou says. no visit, no specialist notes, no follow-up, no prescription. if that leaves you with no patient, GOOD RIDDANCE. better to not be paid for work you're not doing rather than be liable and not be paid for work you are doing. RESPECT YOURSELF, value yourself, be firm, and others will respect how you work, and the work you do. don't enable others' bad behavior, whether doctor or patient. LL ps-- one last thing-- JUST DO IT! Annie Skaggs wrote: But you don’t phone in things on the order of the cardiologist, passed on verbally over the phone by the patient, without seeing the patient… From: [mailto: ] On Behalf Of

l_spikolSent: Thursday, December 20, 2007 12:34 PMTo: Subject: Re: Specialist issues --RANT I consider myself wellversed in cardiovascular diseases that I do refill medications if they are reasonable cardiovascular medications. I follow the patient in any case.>> Agree with Kathy about this... mostly.> > But I also know some of my specialist colleagues are overwhelmed here in western PA. Since I'm still building my practice (cash flow yucky), I sometimes don't mind following the pt for cardiology work, endocrine, etc, BUT I

also will NOT refill Cardiologist's meds as they change them from time to time.> > Also if a letter sent to me, I'll sometimes see pt every 3-6 months as cardiologist can only see them yearly.> > This is usually the exception, though.> > Did have pt contact me last week, post op for large ovarian cyst, VNA seeing too, asking me if I could do her post op wound care instead of travelling to see Gyn -- she and VNA did NOT know the Gyn ALSO sees pts up the road from me once a week.... I of course said NO NO NO.> > Matt in Western PA> Specialist issues --RANT> > I just have to vent.....you can all picture me with my face as red a> Santa's suit and shaking "like a bowl full of jelly", but not because> I'm laughing.> > It started with patients calling me

to say "my cardiologist says he's> too busy to write prescriptions and he said I should just call you and> have you call everthing in and don't change anything. He said my EKG and> Echo and stress test are all OK"> > Then the radiology places all said "insurance won't let us precert those> CTs anymore, so you'll have to do it.> > Then the gastroenterologists told the patients that it was primary> care's responsibility to get PAs for the BID high dose PPI they told the> patient they needed.> > Then the cardiologists said they wouldn't schedule any more stress tests> unless I precert them first.> > Then the colonoscopists said no more colonoscopies if I don't precert> those first> > Then infectious disease and rheumatology required that I "apply" for> consultations: I have to submit records and only after

they review them> and agree to see the patient can I schedule a referral. If they don't> feel like seeing the patient, we're out of luck.> > NOW, I just got a recorded message and a fax from the breast imaging> place: "Mrs so-an-so has failed to keep her appointment for additional> imaging of her abnormal breast. Because contact with a primary care> doctor increases the likelihood of compliance, we are requesting that> Dr. Skaggs contact Mrs So-and so and schedule her for additional imaging> at one of the following times. Please fax a confirmation back with the> date and time that Mrs So-and-so agrees to appear for her recommended> testing"> > And if I object to any of this???? >> "Well Dr Skaggs, don't you want> your patient to have <fill in the blank with a perfectly reasonable> medical recommendation>?" "I guess

we'll just have to tell Mr> Blankety-blank that he might need to find a better medical home"> > This medical home crap is just that: CRAP! It is a tool to coerce me> and you and all of us to work for free. Home may be where the heart is,> but really it is where somebody who loves you will take care of you and> make sure you get what you need, whether they can afford it or not,> whether you deserve it or not and even when they know perfectly well you> will never pay them back> > There, I feel better now. (not really but I have to get back to work)> > Thanks for listening> > Annie>

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