08-03-2020, 11:14 AM
How do you guys handle consults without appropriate imaging?
Last week I had an ED try to consult me for a lady seen one month ago for a tiny right sided parafalcine meningioma who was coming in with new right sided arm weakness with the only new imaging done being a normal head CT.
Next the several neck and back pain consults with negative CT scans from the hospitalists.
And the one I'm not so happy about. A 60 male with back pain, constipation, and urinary retention with a negative CT and ED calling saying the can't get an MRI because of a pacer. I tell them get a CT myelogram if they are really worried about cord compression and if shows anything we will consult and see patient after imaging. The ED doctor didn't really argue with me or fight me on it, he just wrote me up and sent it to hospital administration saying I was refusing consultation. Anyways they were able to get an MRI after all the next day, which came back completely negative.
Any similar experiences or advice on how to handle this? I know some people would say take the easy consultation fees, but we get 10-15 consults per day and I'm trying to cut down on unnecessary ones.
Last week I had an ED try to consult me for a lady seen one month ago for a tiny right sided parafalcine meningioma who was coming in with new right sided arm weakness with the only new imaging done being a normal head CT.
Next the several neck and back pain consults with negative CT scans from the hospitalists.
And the one I'm not so happy about. A 60 male with back pain, constipation, and urinary retention with a negative CT and ED calling saying the can't get an MRI because of a pacer. I tell them get a CT myelogram if they are really worried about cord compression and if shows anything we will consult and see patient after imaging. The ED doctor didn't really argue with me or fight me on it, he just wrote me up and sent it to hospital administration saying I was refusing consultation. Anyways they were able to get an MRI after all the next day, which came back completely negative.
Any similar experiences or advice on how to handle this? I know some people would say take the easy consultation fees, but we get 10-15 consults per day and I'm trying to cut down on unnecessary ones.