Re: Family practice and OB
From: Charlie Chambers (cchamber@embarqmail.com)
Sun Dec 30 14:52:22 2007
Sounds like a good cooperative relationship.
Interesting how each institution evolves their situation. Our current
hospital call relationship is unique from any other place that I've
been to. Each group arranges their own c/s call. For our group it's
easy because we have 3 ob's. But, we're also assigned "community
call" in that if anyone who does not do c/s can call the community
call person to come into do the surgery. The community call schedule
has both ob's and fp's. Any group can hire what ever level provider
they prefer and rely on the community call schedule. For example, the
other ob group in town does not have enough ob's to cover all their
patients so they have a midwife that takes call one out of 3 nights.
If she needs a c/s she doesn't call her group but someone on the
community call schedule which could be one of us, one of their
competitors. Kind of weird, but since it has been place well before I
got here, I've taken the road of peaceful coexistence.
Happy New Year to everyone. Here's to greater peace in the world in
2008.
On Dec 30, 2007, at 11:50 AM, Anna Meenan, MD wrote:
> I have been trying to get around to replying to this one, since I
> am the
> only FP on the list that I know of. I have a unique situation at the
> moment, in that I teach FP residents and we have a group of university
> OB's that we consult with. There is always one of them on call, so
> it's
> not a problem. The OB and FP departments (two separate departments in
> our hospital) got together and agreed on a list of things where
> consultation is mandatory, including some where the case should be
> turned over to the OB. If you want a copy of the list I can probably
> scan it and send it to you as a pdf file sometime when I'm just
> sitting
> on L&D. In general, we don't call the OB and tell them a pt needs a
> c-section. We call them, present the case, and ask them for their
> input. What happens next kind of depends on who the consultant is,
> since some are more comfortable with forceps than others (though I
> don't
> think we have anyone who still does rotations anymore). They do have
> the option of recommending things like continuing pitocin longer,
> therapeutic rest, etc and we go along with what they advise. There is
> an in-house OB at night for crashing emergencies, but they do not do
> routine consults. In general, the FP's send their gyne stuff to the
> OB's who back them up and everyone gets along pretty well. I have a
> friend who practices in Northern Wisconsin who relies on a general
> surgeon to do her c-sections, and he says that when she calls, he
> doesn't want details, just wants to know how fast he needs to
> drive. So
> I guess it depends on where you practice.
>
> I would recommend you discuss it with the other OB's and find out how
> everyone else feels about the situation. Getting both departments
> together and establishing some guidelines would probably be a good
> idea.
>
> Anna L. Meenan, MD
>
> At Fri, 28 Dec 2007, Glen Elrod wrote:
>>
>> Greetings all! I have been away while separating from the service
>> and moving back to Alaska to start a private practice. So far so
>> good, but one thing I've run across at our hospital is with
>> regards to Family Practice and OB.
>>
>> We have several FP docs that are doing OB. We even have one that
>> is credentialled for c-sections. I'm OK with that bit, mostly.
>> What I have found out is that the FP docs do not have any set OB
>> doc backup that they use/consult/etc. When the time rolls around
>> that a patient of theirs needs a c/s, they simply call the EMTALA
>> OB call doc and ask them to 'do a c/s'
>>
>> My question to the group is, is that standard of care across the
>> country? Is that what EMTALA call is meant for? If I were to try
>> and make a change, what sort of legal legal (Joe) do I have to
>> justify them picking an OB and consulting them.
>>
>> Its good to be back.
>>
>> Glen
>>
>> D. Glen Elrod, MD
>> Obstetrician/Gynecologist
>> Sleeping Lady Women's Health Care, LLC
>>
>> newsearch/category.php?category=shopping
>>
>
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Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"... all good things, trout as well as eternal salvation,
come by grace and grace comes by art
and art does not come easy."
-Norman Maclean
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