One of the parts of my job is holding the triage phone. This is not something I enjoy. It feels like folks call me for a way to reach other folks and finagle transfers to our teaching hospital. I am not at my best on the phone and phone tag is irritating.
My first conversation with the outside hospital doctor started with bare bones introductions before she asked me if I was a nephrologist because she wanted an expert opinion on whether her patient needed hemodialysis. Now, this was a woman with lots of comorbidities who had heart failure which was responding well to diuretics but her creatinine has creeped up. We discussed her care and decided that there was no indication for urgent hemodialysis.
My very next call from another outside hospital was for another person with newly diagnosed congestive heart failure with a prior history of chronic lymphocytic leukemia. Now, here even before our introductions, the doctor blurted out, asking me if I was an oncologist. I told him that I was a primary care doctor working in the hospital. We reviewed the details of the patient's history and concluded that he needed management of his shortness of breath before looking at further oncologic management.
It is shocking to me that generalists don't seem to trust their own clinical judgement. Care for a patient often degenerates into a consult-a-palooza where a lot of specialists opine about diagnosis and therapy without a leader of care so that therapy may not always be in the best interest of the patient. This is a common scenario which plays out daily in our hospitals and reflects poorly on our internists.