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MarsRover

Specialties refusing to see certain pathologies

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I recently met an endo who refuses to take any consults for diabetes. I was surprised to hear this as that is sort of the bread and butter of endo. It made me wonder how common this is? I honestly didn't know you could refuse certain illnesses. Does this take place in surgery too? Gen surg who refuses to do lap chole? I obviously understand if something is out of the scope of what the person is comfortable with. 

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oh yeah you can - you don't have to treat particular diseases etc and people customize their practices around that. 

Now you cannot always do it for - for instance if you have hospital privileges somewhere they can insist that you do certain general procedures. You always cannot refuse if it would cause immediate harm to the patients - it would be dumb for an ED doc to refuse ha some actively dying because they "don't do that". 

 

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27 minutes ago, rmorelan said:

oh yeah you can - you don't have to treat particular diseases etc and people customize their practices around that. 

Now you cannot always do it for - for instance if you have hospital privileges somewhere they can insist that you do certain general procedures. You always cannot refuse if it would cause immediate harm to the patients - it would be dumb for an ED doc to refuse ha some actively dying because they "don't do that". 

 

Haha yes, that would be quite ridiculous. "im working trauma tonight, but i only deal with non-acute sorry." 

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1 hour ago, MarsRover said:

I recently met an endo who refuses to take any consults for diabetes. I was surprised to hear this as that is sort of the bread and butter of endo. It made me wonder how common this is? I honestly didn't know you could refuse certain illnesses. Does this take place in surgery too? Gen surg who refuses to do lap chole? I obviously understand if something is out of the scope of what the person is comfortable with. 

This is largely an academic thing. I met a lipidogist whose some sole practice is lipids. As such he can see diabetes but he and his staff won’t do as good a job. 

 

In on academic world (especially UofT) they are all sub-sub specialists and see one or two diseases only bc they get referrals across the province. If you move away from that people will See a wider range 

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When I did my paeds emerg rotation there was one staff who didn’t have an EM fellowship and refused to see any orthopaedic/MSK complaints (and some other stuff). It was super annoying because you’d have to wait until another staff was available to review and once they were all tied up in trauma and the patient had to wait like three hours because this staff “doesn’t do feet”. 

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15 minutes ago, ellorie said:

When I did my paeds emerg rotation there was one staff who didn’t have an EM fellowship and refused to see any orthopaedic/MSK complaints (and some other stuff). It was super annoying because you’d have to wait until another staff was available to review and once they were all tied up in trauma and the patient had to wait like three hours because this staff “doesn’t do feet”. 

well that is just stupid in my opinion ha. If you cannot do the normal stuff of the job then you should be somewhere else 

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3 hours ago, ellorie said:

When I did my paeds emerg rotation there was one staff who didn’t have an EM fellowship and refused to see any orthopaedic/MSK complaints (and some other stuff). It was super annoying because you’d have to wait until another staff was available to review and once they were all tied up in trauma and the patient had to wait like three hours because this staff “doesn’t do feet”. 

That's stupid. If an ER doc can't see the bread and butter of ER they should be let go and replaced with someone who does. 

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1 hour ago, NLengr said:

That's stupid. If an ER doc can't see the bread and butter of ER they should be let go and replaced with someone who does. 

It's actually relatively common for a general pediatrician to help cover a peds emerg as they cost less than an actual peds emerg doc and can help support them with most cases. We don't get msk/trauma teaching in gen peds so the fellowship-trained doc should see those. Usually that means that the fellow doc can focus on that stuff and it works out. It also happens with fam med docs working in rural emerg/urgent care. If there is issues that there is stuff that gets delayed then its for sure a problem and then they should really have mulitple fellowship trained docs +/- the gen peds helper.

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20 hours ago, bearded frog said:

It's actually relatively common for a general pediatrician to help cover a peds emerg as they cost less than an actual peds emerg doc and can help support them with most cases. We don't get msk/trauma teaching in gen peds so the fellowship-trained doc should see those. Usually that means that the fellow doc can focus on that stuff and it works out. It also happens with fam med docs working in rural emerg/urgent care. If there is issues that there is stuff that gets delayed then its for sure a problem and then they should really have mulitple fellowship trained docs +/- the gen peds helper.

In the ER I work in which is mainly Fam docs this isn't true. Mind you most the new ones have the +1 em, and the older ones have been doing it for a while. But they definitely all work a fairly equal amount of shifts in trauma/Acute/non-acute. 

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4 hours ago, MarsRover said:

In the ER I work in which is mainly Fam docs this isn't true. Mind you most the new ones have the +1 em, and the older ones have been doing it for a while. But they definitely all work a fairly equal amount of shifts in trauma/Acute/non-acute. 

Some of the smaller hospitals have newer family doctors who do ED coverage without the +1 who do not handle CTAS 1/resus patients and always work with a seasoned EDP who handles those. Some do mentorship programs to help prepare family docs to challenge the CCFP EM exam after four years of practice. 

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22 hours ago, Birdy said:

Some of the smaller hospitals have newer family doctors who do ED coverage without the +1 who do not handle CTAS 1/resus patients and always work with a seasoned EDP who handles those. Some do mentorship programs to help prepare family docs to challenge the CCFP EM exam after four years of practice. 

They are not allowed to handle it or don't feel comfortable yet? 

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