Presentation on theme: "Nilesh Patel July 22, 2009 St. Joseph’s Regional Medical Center EM Conference."— Presentation transcript:
Nilesh Patel July 22, 2009 St. Joseph’s Regional Medical Center EM Conference
OBJECTIVES Review techniques to effectively communicate with consultants Highlight the DO’s and DONT’s of speaking with consultants Learn how to navigate the difficult consultant
REALITY EM physicians frequently deal with consultants by phone Variety of consultants…Different expertise Develop your own method Bottom Line We need to effectively communicate with our consultants This is an under-taught art of EM
CORE COMPETENCIES Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism System-based Practice Osteopathic Philosophy and OMM
WHAT’S AT STAKE? Job security Job satisfaction Patient care EVERYTHING!
THE PROBLEM EM physician Stress/Heavy patient load Fatigue Work-up Consultant Inconvenient times Stress/Heavy patient load Fatigue The Interaction Phone conversation…disconnect
SITUATION Introduce yourself Chief complaint Example Hi Dr. Rizzo. This is Nilesh Patel calling from the ER. I have Mr. Jones in the ER today. He is a 26 y/o male who presents from NJDC with vomiting and diarrhea for 4 days.
EXAMPLE Mr. Jones has had non bloody vomiting and diarrhea for the past 4 days. No fevers or abdominal pain. He has a pmhx of severe CP, multiple other medical problems and is nonverbal. PSHx of the abdomen includes PEG placement. On vitals, he is afebrile but tachy to 120 with a bp of 120/70 On exam, he appears volume deplete. His mucous membranes are dry, heart tachycardic, with diminished cap refill. His abdomen is completely soft, non-tender with normal bowel sounds. His labs show a normal CBC, normal lytes except a Bun of 40 with a Ct of 1.3. His K is also low at 3.0 with no EKG changes. His abdominal xray shows no evidence of obstruction but is also a limited film.
ASSESSMENT Treatments administered Diagnosis Example We have given Mr. Jones 2 liters of NSS as well as IV K+ replacement and anti-emetics. My assessment is that Mr. Jones has a gastroenteritis with resulting dehydration and electrolyte abnormalities. He may also have colitis. I do not think he has a bowel obstruction or appendicitis because his abdomen is non-tender.
RECOMMENDATIONS Disposition Other suggestions Example My recommendation is we admit Mr. Jones to any medical floor, continue with ivf rehydration and antiemetic therapy and reassess his response.
THE DO’S Do be professional Do be organized Do speak your consultants’ language Do highlight important information Do be concise Do have a plan May lay out plan early in conversation
PEARLS Get to know your consultants Respect your consultants Make the proper referrals Know when to back down; when to stand up & stick to your guns You have to “sell” the case The “prn” phone call
THE DONT’S Don’t be rude Don’t keep consultant waiting on phone Don’t be indecisive/disorganized Don’t say “I have no idea what is going on” Don’t lie
DIFFICULT CONSULTANT Be respectful, prepared, and honest Remember appropriate patient care takes priority Silence can be golden Stick to your guns when necessary Take the high road Go to a third party if necessary—attending, administrator
YOU MAY HAVE HEARD THESE… “This patient seems low risk to me” “I have known this patient for years” “There is not much that can be done for this patient” “If this patient is admitted, they may get a nosocomial infection” “This sounds like a social admission”
TELEPHONE TIPS Introduce yourself Be concise and organized Lay out expectations…Know why you are calling Review patient with attending prior to phone call Be honest
CASE 1 CC: SOB HPI: 82 y/o female presents with SOB and cough for 4 days, fevers. SOB worse with walking. Positive cough, chest pain with coughing. Positive nausea, no vomiting PMHx: CHF, DM, CAD, COPD Meds: Diovan, Lasix, Insulin, ASA, Plavix, Spiriva SHx: Former heavy tobacco use
CASE 1 PE VS—T102, 115, 24, 120/70, 93% RA HEENT—MM mildly dry Lungs—crackles at L base with scattered wheezing Labs WBC—16.5, N80, B8 Na—129, Bun—35, Ct—1.8 EKG—sinus tachy, nonspecific ST/T changes CXR—positive LL infiltrate
CASE 2 CC: Chest pain HPI: 40 y/o male presents with acute onset of substernal chest pain. Pain pressure-like, radiates to L shoulder. Positive associated sob. Pain relieved upon presentation to ER, lasted for 4 hours. PMHx: HTN, Gout Meds: Norvasc, Atenolol SHx: Positive tobacco use FHx: Father with MI at 51
CASE 2 PE VS—T98.7, 90, 20, 160/90, 99% RA Normal Labs Normal EKG Sinus, T inv V2, V3, V4 (no old ekg) CXR Normal
CASE 3 CC: Weight loss HPI: 54 y/o male presents with weight loss over the past couple of months. Positive urinary frequency. PMHx: none Meds: none FHx: Mother, brother, sister all with DM
CASE 3 PE VS—T98.7, 85, 16, 130/80, 99% Exam normal Labs Finger stick 370 SMA 7 normal except blood glucose, AG 7 UA with moderate glucose, no ketones
SUMMARY Effective communication skills Patient care Have a technique Do’s Dont’s