|
The Value of the Toenail Consult…
I recently had the opportunity to give a lecture on lower extremity wound care to a group of Hospitalists at the local community hospital, and during the discussions which followed my talk, my medicine colleagues and I found ourselves discussing our specialties, and formulating ways in which we can further integrate our practices to promote coordination within the hospital and create a higher level of care for our patients. These hospitalists had many questions about podiatry, and care that we can provide. I found the discussion extremely valuable; not only did I receive three new consults, but I also had the opportunity to educate my medicine colleagues on the nature of our profession, and the skill-set that we can utilize to provide care for our mutual patients.
Reflecting upon our follow-up conversations, I was motivated to write a piece regarding the value of developing relationships within the local hospital community. On a whim, I did a search on the PRESENT Podiatry website (an excellent first step when you want to learn about a podiatry practice related issue) and lo and behold, I came across this excellent piece already written by my esteemed colleague Jarrod Shapiro, DPM, who wrote this piece on hospital consults, and their value in practice building.
—Ryan Fitzgerald, DPM, PRESENT RI Associate Editor
| |
|
Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA |
Hospital Consults:
A Satisfying Practice Builder
by Jarrod Shapiro
When building a practice, many new physicians may think first of mailing advertisements and meeting referring doctors, or perhaps word of mouth. As important as these sources may be, an under-considered referral source for many is the hospital consultation. For those of you who enjoy office practice, I’d like to recommend expanding your practice to include hospital consultations. The benefits are manifold and more than outweigh the disadvantages.
Practice Building
Performing consultations in the hospital exposes you to a potentially large source of patients for your office practice. These are the nurses, students, orderlies, techs, assistants, and other members of the hospital staff that often suffer from foot and ankle problems. Every person you meet, while performing a consultation , is a potential patient. Keep in mind they have children, parents, and friends who also may require your services. Additionally, the physicians you perform the consult for has – in most cases – an outside practice with a large number of potential referrals. Performing a comprehensive consultation displaying your clinical acumen will lead to more office referrals. Finally, many consultations may lead to surgical procedures and the fees that come with them. Think of the entire visit to the hospital as an interview that you were fortunate to get. How many people can you meet and greet, and impress with your pleasant demeanor and valuable skill set?
Intellectual Interest and
Referral Patterns
Many hospitalized patients will have a range of complex medical illnesses and lower extremity pathology. I've been lucky enough to treat a variety of pathologies from nail fungus and gout, to severe diabetic limb salvage cases, to emergent trauma patients. By simply reviewing orders, you can stay current with treatments of other disorders. This is a valuable and free learning experience for you. When time permits, I'll read through other consults simply to see how other specialists treat pathology. The opportunities to interact with other specialists and continue learning abound. This is also a great opportunity to learn about the skills and personalities of your medical colleagues in the community. Who refers to whom, who are the influencers, how is the game played in that hospital setting ? It's all there in the chart...
Chance to significantly affect
your patients' lives
These are often very sick people who will benefit greatly from your interventions. The satisfaction that comes with salvaging a limb, repairing a fracture, or treating a limb or life-threatening infection is a great benefit of practicing hospital medicine.
The Disadvantages
When I was a student, one of my trainers said, "Pus doesn't take holidays." That's absolutely true. I've spent many nights in the OR treating patients when I could have been home with the family. Consults are not part of the 9-5 office schedule. If you can't live with this fact, then don't do hospital consults. I would guess, though, that the majority of us understand this and became physicians in spite of the hours. It's also possible to receive consultations on patients with poor or no insurance. I accept all consults that are requested of me, whether the patients are insured or not. I present it as a courtesy to my attending physicians, though I try to keep this as much to a minimum as possible. The advantages are all listed above, even if you are not getting paid for every consult.
Recommendations
Here are some suggestions to build the hospital side of your practice.
-
Get on Staff If you’re not already, get on staff at your local hospital.
-
Walk the Floor Visit the hospital, focusing on patient floors and nursing. In many hospitals, the charge nurse is responsible for calling on the consults, and they choose who gets called. When I practiced in Michigan, the attendings would order “consult podiatry,” and the charge nurses would call me, since they knew me well. Bring a box of donuts or other suitable treat and don't be shy about telling the charge nurse why you are giving her station a treat.
-
Bring a Brochure about your practice to educate the nursing staff. Include convenient contact information and your pager.
-
Let the Community Know You are Available As part of your marketing plan, inform your physician referral sources that you are available for hospital consultations. A letter to each office will go far here.
-
Take the Bad with the Good. You may receive toenail consultations, but do them in the same comprehensive manner you would any other consult and with a positive attitude. Don’t come across as arrogant by taking only the “cream.” Your referring physicians will appreciate the help. Consider it also as another opportunity to gather more patients. Remember, that toenail patient has a family.
-
Get there Fast Respond as rapidly as possible to a consult request. For example, I tell my docs that I’ll do same day consultations on emergent in-house issues (diabetic wounds, etc) and within 24 hours for nonemergent issues (onychomycosis). I’ll respond quicker when time permits.
-
Put on a Show, and Shine When you see a patient in the hospital, educate them on their problem. Show them you are the best at what you do, and they will follow-up with you after they’re discharged.
-
Look the Part Consider carrying a medical bag with basic supplies and instruments. You’ll save time by not having to search out supplies on the floor.
-
Prepare Call ahead to the floor when you’re coming to see a patient. They may be unavailable, at other tests or procedures.
|
For those of you who spend time in the hospital, what tried and true methods work for you? For those who stay away from the hospital, what concerns or issues keep you away? Write in with your opinions.
I Look forward to hearing from you! And I encourage each of you to share your thoughts, perils, and experiences in the eTalk section of Present Podiatry. We all grow from the shared knowledge of our online community!
Best wishes on your next hospital consult.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
Get a steady stream of all the NEW PRESENT Podiatry
eLearning by becoming our Facebook Fan.
Effective eLearning and a Colleague Network await you. |
 |
This eZine was made possible through the support of our sponsors: |
Grand Sponsor |
 |
|
| Diamond Sponsor |
 |
|
Major Sponsors
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
