Posted by: notdeaddinosaur | January 7, 2009

Insufferable Twits and "Shitty Consults"

One small agreement doesn’t make for much of a truce, at least when certain insufferable twits post nonsense like this.

The topic is so-called “shitty consults.” A certain hospitalist of ill repute reduces all consults into a punnet square of time and effort, in which any virtually every encounter with a consulting physician can be labeled “shitty.” Qualities which enhance the “shittiness” of the consult include those that take time (too much, presumably) and dealing with patients who are awake, hospitalized, sick and/or have multiple problems. Of course the level of payment that can be expected is a major contributor to the “shit” factor, as are those consults that occur at inconvenient times of the day (or, more frequently, night.)

Look, I understand as well as the next guy that the internet in general and the medical blogosphere in particular is a place to vent. I don’t deny that much about hospital medicine can be frustrating, and I have no problem with generalized bitching and moaning about it. But in spite of the world’s wimpiest disclaimer (“Docs, you know it’s true, however crass that statement is,”) labeling sick people in need of help — whatever their insurance status — as “shitty consults” is over the line. Hey, emergency medicine has a set of patients they hold in similar contempt, but at least they have the finesse to use euphemisms like “frequent flyers” or cool neologisms like “fibromyalgeurs” and “crayzees.” We in outpatient medicine have our PITA patients as well, but as a rule, even we call them “bullshit” instead of just plain “shit.”

Tell you what: I think we should eliminate all payment to doctors for hospital services. Just pay the hospital and let them deal directly with the hospitalists, a profession that ought to expand to include inpatient versions of all the other specialties. Surgeons and OBs are moving to this with surgical hospitalists and “laborists.” Expanding it to include interventional cardiologists, pulmonary intensivists and all the others HH has to consult with (but very rarely, because his skills are so broad he can handle just about everything his hospitalized patients may need) is just the logical next step. Let them all work out a schedule so there’s all the in-house coverage they need. Hell, maybe the hospital can truly become operational 24/7 instead of shutting down at 5:00 every day (4:00 on Fridays until Monday morning.) If nothing else, they may come to realize that taking care of hospitalized patients is actually their job, as opposed to just a series of “shitty consults” imposed on them while they’re trying to cobble together a living taking care of ambulatory patients.

Seems to me there are far more shitty consultants than there are “shitty consults.”


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