Received a page last night from an ER doc at the community/referral hospital I maintain privileges at in addition to the small critical access hospital I attend. A patient of mine was sent over from an assisted living facility for a seizure. The physician had a few records from prior ER visits and a medication list from the facility, but he wasn't sure what to do with this guy.
Fortunately I've known this ER doc for the last eight years and he's been practicing for at least twenty. So he decides to page me and talk the case over with me. Yes, he probably did have a seizure, but we decided given his history and the initial ER tests we could tune up his medication and I'd keep him on my radar and closely follow up with him in the office.
Unfortunately this approach seems somewhat old fashioned. With great confidence I can say if this patient had seen a different ER physician at the same hospital on the same night things would have gone much differently. Another physician who perhaps did not have as many years of experience or who did not know me personally would never have made that initial call. He probably wouldn't have realized I maintained privileges at that hospital since so many family physicians have dropped them. This patient would have been admitted to the hospitalist service where no one new him from Adam and he would have had a three day admission full of unnecessary tests which at the end of the day would have resulted in the same plan this ER doc and I devised in about five minutes.
How many health care dollars did that five minute phone conversation save? Between hospital charges, MRIs, EEGs, hospitalist charges, neurology charges it would have easily been in the five to ten thousand dollar range. So how do you incorporate cost containment like this into health care reform?