Frustrated beyond belief...

[AngelfireRN, MSN, RN, APRN]

You know, I love my job, I really do. I have never been able to say that after 3 months before, and I'm happy that I can say it now. Besides the hour drive to and fro, which really doesn't bother me overmuch (that's why God made iPods and Rick and Bubba). But something is really starting to get on my nerves.

I would estimate that roughly 50-75% of our consults are nonsense. Stupid stuff that should never have darkened our door, ordered by equally senseless or clueless providers who just want to pass the buck. Or maybe it's just plain ignorance of what SHOULD be done, and not stupidity, I better clarify that. I would be willing to be that out of every ten consults we get, 9 of them are nothing. Very rarely are the standard tests to check for problems that we need to see done. There was even one about a month ago with a "R/O potentially bad diagnosis", and no labs, CXR, ECHO, or EKG was even ordered. Just "Admit to Dr. So-and-so, dx: R/O XYZ, consult Dr. Thus-and-such. Period.

It irritates me, because, the patients have to pay for it, whether or not their problem is related to our specialty. I know, I know, that's how I make my money. But it gripes the docs, and it gripes me as well, since I usually do the initial consult. I mean, it makes it easy for me when the plan consists of "monitor labs, continue current meds, etc." , but it just does not make sense.

Am I being overly dramatic? Does this happen to any of y'all? I know this is my bread and butter, but it makes me sad to think that these poor people have to pay for us when we're not what they need. Thanks for letting me vent.

[Flare, ASN, BSN]

Let me applaud you for wanting to be part of the solution.

I tend to think that we live in such a litigious society now that those ordering consults will do so for things that are terribly remote with the intention of covering their own rearends. So rather than sitting down and talking to patients and saying that dx XYZ could be a remote possibility they just decide to pass the old buck and label it CYA in tehir own mind. It seems the better the insurance, the more common this is. I would imagine that you would not refuse a consult - like you said -it's how you pay your own bills - but perhaps if you are seeing a trend from a certain referring doctor, maybe you could educate him/her a bit better that the consult may not always be necessary.

[itsmejuli]

Yes, the doctor's who are doing the referrals are doing CYA.

But...here's something to think about too.

I used to work in medical insurance paying and adjusting medical claims. There is rampant fraud out there.

If these patients are insured, who is their insurer? Do you notice a trend in the referring docs and the patient's insurance?

If you want to get involved you can report suspected fraud and abuse.

PM me if you need the info on how to report fraud.

[meluhn]

Welcome to acute care. This bothered me alot when I first started at the hospital but I am used to it now. If a person coughs once they order a pulomonology consult. After a while they have so many consulting mds on the case it is ridiculous. If you ask one about the wrong body part they get all peeved and tell you to call that specialist, "I only deal with kidneys" or whatever the case may be. At my hospital the patients are mostly medicare so its not about the insurance. I think they do it to keep their buddies busy and feed their wallets. They all thank the refering docs like they did them a big favor.

[AngelfireRN, MSN, RN, APRN]

Oh, I don't think it's so much fraud as it is just ignorance or plain old "I don't want to deal with this".

We frequently get consults that state that a pt has a certain condition, only to interview the patient and find no evidence of the condition, nor any history of such. I tell you, this place has better mysteries than Columbo ever had.

[maggiernpainnurse]

Angelfire I know what you mean about the referrals that are a waste of time. I don’t know about you, but part of my job is to do prior authorizations. When you go through the time spent going through the automated messages, put on hold, transferred to a different department, get disconnected and start the process all over again. :smackingf Then when the patient gets here we often get “I don’t know why I am here”.

Hey we must live pretty much in the same part of the world because I too listen to Rick and Bubba, in fact one of my nurses husband is the general manager of that station. Small world.