You dont really believe this is what PCPs tell these patients
I am hospitalist and I am gonna go out on a limb to say no PCP will tell a patient to see a specialist w/o telling that patient why.
You gotta give your colleagues a little bit more credit than that.
Healthcare/medicine is very complex and most patients have ZERO understanding of what going on with them even if you explain things in layman terms. It's not the fault of neither the patients or the clinicians.
that was a bit tongue in cheek in this example
for this PCP (who sent the referral reason to me ahead of time and said "lung cancer screening and COPD check in a smoker"), I actually welcome this blank slate. It can paint a picasso on a blank canvas.
on delving more deeply and review the referral reason the patient said "oh sure yeah check my lungs out since I smoke yep."
anyway I have a more professional working relationship with the hospital based doctors (primarily thoracic surgery, interventional pulmonary, infectious diseases, and CHF/PH cardiology) with whom I can either call/chat or share updates in EPIC through patient messaging.
but those community "randos" who send me patients - thanks and I will do my part to help you and our new mutual patient. but gaslighting of your patient ahead of the visit is not appreciated. I will attempt to be empathetic and make the assumption that it was not a malicious intent on the part of the PCP but rather the patient is just a "nervous inconsolable wreck who has delusions of granduer and undiagnosed schizoaffective disorder." but in that case, some word of caution ahead of the visit would be appreciated.
another recent referral was "patient has lung nodule needs follow up CT scan but I tried to get prior auth and failed. please assist."
sure glad to help
review of workup - Right lower lobe 0.3cm nodule incidentally found on CTAP as part of kidney stone workup in a nonsmoker / no radon / no biomass fuel / no family history / no aerospace / etc....
yeah already its not indicated per Fleischner criteria. but in real life, some patients are scared to heck and would like a full CT to make sure nothing is wrong in the upper lung zones. CXR normal so at least nothing over 1cm most likely
in this individualized case , reasonable to do one time CTC
the patient comes - feels totally asymptomatic and no complaints. for this patient I do not put him through unnecessary PFT or other testing if he has no symptoms, abnormal findings, or potential for lung resection surgery
He brings in the insurance denial letter. He telsl me "the PCP told me only a specialist can get this approved."
I read the letter and denial reason to the patient (this patient is Caucasian and speaks English well. he works a poet in NYC. nice guy)
in the print I read - 71271 is denied because the patient does not have a smoking history. But 71250 will be approved if requested.
*facepalm*
For this situation, someone just has to reply to insurance (not even a phone call. just an efax with the plan referene # for the prior auth and a letter stating - yes I would like to get approval for 71250 as is offered) .
logically this means
1) the PCP did not bother to read because "i was paid to lead, not to read"
2) the PCP was under the impression a phone call was required? this would be even more egregious
3) the PCP wanted a specialist on board? if so the PCP should have gotten the CT done first.
I waived this guys copay and just billed the lowest 99202 and said let me know when its done and report is in.
It's not the fact that many local PCPs are sending me very basic cases that any internist shoudl be able to handle (as I have said before, I welcome these easy softball cases and am happy to help). It's the extra large helping of "gaslight" that I could do without.
I am brainstorming what possible reasons there are for a physician to gaslight a patient?
The only reasons I can come up with are
1) I do not know how to manage this but I am too proud to admit it so I will gaslight you instead
2) Because I feel bad I cannot manage everything for you, I will gaslight you into thinking I am a heroic figure on your side as I refer you out
3) The physician does not think there is anything wrong and he/she is trying to be helpful.
When I see patient as primary, if it's something I really don't know how to work up, I admit it
"Hey we did a basic workup. your liver workup is negative for viral hepatitis, mono, autoimmune, hemachromtoasis. Perhaps it is steatohepatitis based on the book diagnosis. but I do not have the training or confidence to make that diagnosis without missing something else. I would like you to see a specialist to ensure I am not missing anything."