Primary care problem in specialty

Specialties NP

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Specializes in Pediatric Pulmonology and Allergy.

Let's say you are working in a specialty and a patient presents with a complaint that is outside that specialty. Let's assume the problem is straightforward and something you have experience diagnosing (say, AOM). Would you write a prescription for them during the visit, or refer them back to their PCP?

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The problem with writing that prescription would be the lack of follow up with that patient which may make you liable if something happened as a result of the treatment. Im assuming that since you are in a specialty setting you wont be making a follow up visit for that primary care problem.

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Specializes in critical care.
The problem with writing that prescription would be the lack of follow up with that patient which may make you liable if something happened as a result of the treatment. . .

Just curious, but wouldn't it depend on what's being prescribed? If follow up is not required by the PCP, why would it be required of the specialist?

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Specializes in Nephrology, Cardiology, ER, ICU.

I work in nephrology seeing dialysis pts. There is a new model of care (that our practice has NOT fully endorsed) whereby we would do primary care. I see these pts 3-4 times per month. I can not undress them, nor can I do an in depth exam. However that said, I do what I can as long as I can follow up.

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Just curious, but wouldn't it depend on what's being prescribed? If follow up is not required by the PCP, why would it be required of the specialist?

I always like to follow up on my patients if possible (some of them may not return to follow up appointments), especially if a prescription is given for acute disease such as AOM to ensure resolution. Even if the problem doesn't seem too complicated I would still give them a follow up visit. You never know what could happened and in the event you are sued you defense is going to be a lot stronger with a follow up visit. Just my opinion.

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Why do it to begin with? I understand the desire to help, but if you're in cardiology your job is doing cardiology. I live in a pretty black and white world though.

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I wouldn't. I work in a specialty and I try really hard not to look at anything that is outside my area of expertise. I don't want to be liable for those things I don't normally do. I also do not order a test that would reveal something I don't treat UNLESS I plan to refer that pt back to primary or other specialty.

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Specializes in Adult Internal Medicine.

Retail clinics do it without a problem, though I would hope the specialist would notify the PCP.

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Specializes in Nephrology, Cardiology, ER, ICU.

It is a matter of follow up. You want to ensure that the pt is getting better. You want your documentation to reflect that.

Much also depends on what your practice expects of you....

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Specializes in FNP, ONP.

I require my patients to follow up. If they don't, I don't renew their prescriptions (and I only give them 14-28 days worth at a time for a new condition/diagnosis). In my area, most specialists will not treat any primary care issue, and EDs/urgent care certainly will not. My patients complain constantly that they were told "That is a primary care issue, go see your PCP." Last week OB/GYN sent me a pg patient with a runny nose. They would not even discuss it with her. I am certain the OB doc remembers how to treat rhinovirus from his rotations, lol. He knows to tell her she needs fluids, rest, humidification; he just won't go there b/c it is outside his specialty. I suspect part of it is that dictation/documentation surrounding those complaints do not fit nicely into their templates!

Check your malpractice insuranc and make sure that you would be covered if there was a problem while you were treating something outside your specialty.

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Specializes in Pediatric Pulmonology and Allergy.

Good point about follow up, although some chronic kids are in the specialist's office more than their PCP.

Last week OB/GYN sent me a pg patient with a runny nose. They would not even discuss it with her. I am certain the OB doc remembers how to treat rhinovirus from his rotations, lol. He knows to tell her she needs fluids, rest, humidification; he just won't go there b/c it is outside his specialty. I suspect part of it is that dictation/documentation surrounding those complaints do not fit nicely into their templates!

Check your malpractice insuranc and make sure that you would be covered if there was a problem while you were treating something outside your specialty.

Weird about the OB referring a patient back for a runny nose -- I think I'd trust an OB more than a PCP for advice on how to treat common ailments during pregnancy. Also, I'd want to know if my symptoms were a manifestation of pregnancy or just an everyday bug. I developed migraines during one pregnancy which I never had before or since -- I think the OB should be the first person to discuss this with.

Regarding my specialty, I'm a PNP so I'm pretty sure I'm covered as long as the patient is under 21.

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When I was pregnant, my ob/gyn gave me prescriptions for allergy. Am so glad he didn't send me to a pcp.

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