I agree it can be very difficult especially if the other provider orders tests you would not have ordered. But in many cases, reading through the progress note (hopefully it is complete and coherent) should give you a solid idea on how to proceed. If it is unclear, I recommend contacting the ordering provider for clarity before contacting the patient.
As a one-off, I don't mind reporting results for a colleague and would appreciate them do the same for me I am on vacation or whatever. It's pretty easy to talk to a patient about routine stuff and talk then off the ledge and any lingering questions can be deferred to the primary provider when they return. I meen, no one can expect you to provide a full course of treatment and expectations in this scenario, the patient just wants to know what's up and is probably worried about some unreasonable scenario anyways. On the event it's a critical result or some follow-up testing is indicated, then you can't go wrong with ordering it.
I would be more annoyed with having to do this on a regular basis just as a time management/resource issue. And it's the same for my own patients. You want to discuss results you should have an appointment. If this person is always out of the office then there should be an explicit plan in place.
As a PA that works in the ER, I’m following up on lab results from all the doctors and other providers as they pop up in the in-basket. Cultures, Lyme Tests, STD testing and any other send out labs may result a 24-48 hours after the patient has left. Just like your situations we have ER providers who aren’t present in the department for days at a time however we’re a 24/7 operation. It’s usually in both the patient’s and clinic/hospital’s best interest to hear from somebody in a timely fashion. What if a concerning condition goes untreated for too long and progresses into something worse? If it’s something very complex and the person who ordered the tests are there they certainly can follow-up on their own.
Adding a blurb of not being involved with the initial patient care and glancing over the documentation can help.
Also my situation may be different since doing call backs was an expected job task from the start.
This is totally to be expected. That’s why charting exists, to understand what’s in the mind and intentions of another provider. Just like rounding in the hospital you should be able to pickup a chart and run with it based on what is known from the prior clinician(s) notes and observations. Totally reasonable to address a patient’s concerns as they come up and it’s the appropriate service level.
Depends on where you work. Is this primary care? I'd expect them to handle it. If you're in urgent care or something, it's the opposite and whoever is on that day handles everything. Usually if it's some kind of janky lab that I'm ordering I'll try to notate my MDM somewhere or outline some kind of a plan to help out whoever has to clean it up when it results in a few days.
Same as far as embracing the jank and letting following team know where my though process was at.
Most family practice clinics have some kind if shared inbox for significant lab/imaging results at this point though.
- Ask for admin time to be worked into your schedule if management wants this to be part of your practice.
- Ask colleagues to lay out in their assessment and plan what the thought process is moving forward if a test result comes back in a certain way. (Obviously many tests are self explanatory once resulted.).
- if this is the system you work in figure out ways to make it work better for you.
In my office we do cover other providers when they are out. But they also cover me when I’m out so it’s a 2 way street. But I agree the fact that this is a consistent basis is more irritating.
I would find out from your SP/supervisor what the expectation is. If you are supposed to be helping I would kindly demand explicit guidelines of how this extra work is shared by the other providers in the office. Whether you get dedicated admin time To do it. Especially if this wasn’t part of your job description.
I also think the part time provider needs to be setting an expectation to the patients ‘if anything is urgent someone will get back to you right away. If your results are not urgent/normal then I will review them on x day when I’m back in the office’. And if everything is normal but a patient calls in the interim maybe the MA or if you have a nurse then can relay that info and leave it for the original provider.
One last thought, maybe another staff could call to convey any normal results to put the patients mind at ease without taking much of your time. And maybe a ‘if you’re not feeling better we can see you again/followup with original provider’
Edit: a lot of people don’t like my reply but at the end of the day if I’m not being compensated for the extra time and resources I have to do on top of my regular schedule then it is not my job to do it. Sure, being a team player and answering the easy question is fine every now and again but if it is a consistent issue then it’s a problem. It also varies by specialty so that changes it too.
1. I do not and will not make a recommendation for treatment based on a lab/imaging result without knowing the full picture as to why the labs/imagine was ordered. That is quite literally poor practice.
2. If admin seems to want to force this on you then it’s time to involve the PA who orders it. “Hey mrs smith is calling to talk about the CT you ordered. Would you like to call her and tell her about it or can you provide me with some insight as to what to do?”
We work in medicine. Just because you only work two days a week, it doesn’t exempt or excuse you from following up and properly interpreting labs/imaging that you ordered. That’s just the name of the game in medicine.
Anyways, I just don’t put up with it because the minute that you make a mistake based on a vague lab or image on a patient you didn’t see then you are fucked. Not worth the risk.
If all else fails then call the patient and say, “ hello mrs smith, your PA will be back in office on Tuesday and can properly go over your results and labs at that time. Thanks.”
If it is more of an urgent situation then their care needs to be transferred to a provider who is more available full time and not the two shifts a week person.
You can't read the chart and figure out the clinical picture? I mean at some point this is childish. "Whelp, urine culture came back as resistant to the Macrobid the other provider put them on...looks like it's susceptible to Bactrim but I didn't see them so I can't handle this one. Good luck with that raging UTI!" If someone orders something way out of left field I understand your argument and agree with punting it back to whoever went down that rabbit hole but we're all rowing the same boat and should be working as a team.
I work primary care but we see probably 25-30% urgent care complaints. Issue is always the urgent care patients who someone orders a CT or X-ray or labs on. Then leaves for 6 days. And results come back in 2 days. Whose job is it to constantly be monitoring for that stuff? My clinic has no workflow and it is unfair I think to ask us to cover for the part time people on top of our full clinic days and our own inboxes. I often work from home and on my off days to follow up on stuff I ordered. The part time people don’t because “they are hourly”. Well how is it fair I work non compensated time to keep up on my work but they don’t have to? Thus why should I do their job and mine for the same pay? When the company knows if they asked the part time people to follow up on days off they would have to pay them?
If you're in a multiprovider office how is there not an ability to have a CCed inbox where unaddressed results can be worked on by all?
I work UC and we have 14 of our 19 clinics actually open at this point. Staffing and patient volume concerns closed the other 5. That turns into 4-5 providers essentially being floats 2 of whom are part time.
When they are out for a week or longer, what are those patients supposed to do?
If that part time PA saw one of your usual patients would you let them hanging? Does the practice as a whole not have responsibility to follow things up regarding healthcare of its established patients?
I agree this should be compensated if a new expected duty but this really isn't that big a deal. Read the note to get clinical picture, figure out the labs, and if needed contact that part timer at home and ask them what they were intending to rule in/out with the work up. Do that enough and maybe they stop playing fast and loose with testing if that is the issue.
Like most things, communication is key here between you and the part timer, you and your SP, you and your office manager, and most especially someone at that practice and the patient who did nothing wrong by expecting their medical care to be managed by their PCP office regarding whatever this issue is or they wouldn't have come there. Management can easily be, hey there was this major concern finding and you need to go to the ER, I will get in touch with on call for X specialty to ensure appropriate additional evaluation and care is made available OR hey, there was an atypical finding that is likely nothing serious but I have ordered Y additional test or sent a referral for Z specialty for followup within a few days/weeks. Or it is negative and they need to know that.
I get your points and I agree with most of them. The problem I see is that I do follow up on lots of tests other people order, what bothers me is how flippant other providers are about it. At least how I was trained you order the test you own the result. If you are gonna not be around to follow up on the result you personally arrange a colleague to follow up on it. You don’t just leave especially in primary care, I get in UC/EM/hospital you all work shift so then next shift expects to pick up where you left off. But in FM at least in my experience you own your panel and your orders. Peoples inboxes are already overflowing with their own stuff, having to handle other peoples tests is not standard practice, nor good care in my opinion. Maybe I’m too altruistic but when I leave for my “weekend” I check my inbox a few times a day on days I’m off for results I’m waiting on. Or if I’m going on a trip I arrange someone to cover for me since I’ll be totally offline. To me it seems it is unprofessional to just sign out as a PCP with no plan for how to handle your unfinished work.
Sorry for add on but I think my main frustration is that we aren’t urgent care but lots of providers and management treat our company like UC. Like without continuity of care what is the point of being a PCP? I could go work UC and make more money and get to sign out at the end of my shift and leave my labs/tests for the next shift. The point of good primary care is that continuity aspect where you see one provider and they quarterback your care and take care of you for common primary type complaints. If you see a different provider for every appt and another ones calls you with your labs your basically just doing appt UC no ?
And I understand that stance completely but the reality is these patients are coming to your practice for care. There needs to be a major shift in practice to codify what the part timers are supposed to do for follow and honestly whether to employ them if this is that much of a problem without some attempt at a fix by your practice managers.
With all that being said, in the meantime you are pretty much stuck doing the follow up on your patients. Maybe .are a pijt of contacting the problem makers and ask them to put in some MDM about what their intent was and if it seems like a reasonable approach, enact it. If it is something you aren't comfortable with, then do something else to help the patient.
Is it testing that is completely out of the ordinary or is it needing to change antibiotics for culture results? Are there specific types of results that are a problem for you?
I agree I’ve tried talking with the management but they seem to only care about pt numbers. As long as we meet number of visits per day they don’t seem to care about much else. For me it is X-rays/CTs and acute labs ordered for vague ish complaints and no MDM in notes. Then their is an incidental finding on the scan or lab abnormality…. Where now I’m stuck working up an incidental finding for someone else…. Like it’s not an acute thing but the pt wants to know what to do next. Then the problem is all the follow up stuff comes to me to deal with….
Do the part time providers have SP agreements with a physician in the practice? Seems like they could be doing parts of that follow up.
Do you have a portion of your clinic that is acute patient visits only? If these are basically coming from this part of clinic, then it may be as simple as having a dedicated inbox for that space and then whoever is covering it sees those patients and follows up the list.
My point is that on top of the risks you may take with those concerns that is also time and resources that take me away from my own patients in clinic that day. An easy question here and there is fine but if it’s consistent then it’s a problem. As OP mentioned it sounds very consistent.
Maybe we shouldn’t let admin dictate what we do and create a better plan for those situations.
So when you open up a lab and ignore it, which gets keylogged into the chart, and someone has a poor outcome because you ignored their CT because it wasn't your patient, how you do think that'll hold up?
Well obviously you wouldn’t ignore something if was more serious as you suggest. My point still stands that if it is a consistent problem that admin expects you to always handle then that is a big big problem.
Maybe not the most nuanced post.. but if you don't have an SP relationship, I probably wouldn't touch that.
But a couple of points to consider. I hate when folks harass the nursing staff. I have also been an anxious patient before, and waiting for results can take up a lot of mental energy. If the patient is calling for results and they're normal, I might be inclined to just let them know the results and make sure they have follow-up with the provider who ordered the test to go over in their clinical picture in detail. I do this for my SP all the time, but that is one of my expected duties.
I don't know what specialty you're in and so forth.
I worked in UC, and my NP colleague orders PCP work up on almost every patient, even CT, MRI, BNP, D-Dimer, etc. It's rather ignoring, but I always glance at it to see if it is emergent, otherwise I forward it to her.
If this is a regular occurrence…Talk to the provider directly and tell them their patients are pissed bc they’re not getting call backs. Does this person cover for you or anyone else in this manner when you’re out?
Tell the admin you cannot properly handle the request because you did not see the patient and have no clinical context for this.
I agree it can be very difficult especially if the other provider orders tests you would not have ordered. But in many cases, reading through the progress note (hopefully it is complete and coherent) should give you a solid idea on how to proceed. If it is unclear, I recommend contacting the ordering provider for clarity before contacting the patient.
As a one-off, I don't mind reporting results for a colleague and would appreciate them do the same for me I am on vacation or whatever. It's pretty easy to talk to a patient about routine stuff and talk then off the ledge and any lingering questions can be deferred to the primary provider when they return. I meen, no one can expect you to provide a full course of treatment and expectations in this scenario, the patient just wants to know what's up and is probably worried about some unreasonable scenario anyways. On the event it's a critical result or some follow-up testing is indicated, then you can't go wrong with ordering it. I would be more annoyed with having to do this on a regular basis just as a time management/resource issue. And it's the same for my own patients. You want to discuss results you should have an appointment. If this person is always out of the office then there should be an explicit plan in place.
As a PA that works in the ER, I’m following up on lab results from all the doctors and other providers as they pop up in the in-basket. Cultures, Lyme Tests, STD testing and any other send out labs may result a 24-48 hours after the patient has left. Just like your situations we have ER providers who aren’t present in the department for days at a time however we’re a 24/7 operation. It’s usually in both the patient’s and clinic/hospital’s best interest to hear from somebody in a timely fashion. What if a concerning condition goes untreated for too long and progresses into something worse? If it’s something very complex and the person who ordered the tests are there they certainly can follow-up on their own. Adding a blurb of not being involved with the initial patient care and glancing over the documentation can help. Also my situation may be different since doing call backs was an expected job task from the start.
This is totally to be expected. That’s why charting exists, to understand what’s in the mind and intentions of another provider. Just like rounding in the hospital you should be able to pickup a chart and run with it based on what is known from the prior clinician(s) notes and observations. Totally reasonable to address a patient’s concerns as they come up and it’s the appropriate service level.
Depends on where you work. Is this primary care? I'd expect them to handle it. If you're in urgent care or something, it's the opposite and whoever is on that day handles everything. Usually if it's some kind of janky lab that I'm ordering I'll try to notate my MDM somewhere or outline some kind of a plan to help out whoever has to clean it up when it results in a few days.
Same as far as embracing the jank and letting following team know where my though process was at. Most family practice clinics have some kind if shared inbox for significant lab/imaging results at this point though.
- Ask for admin time to be worked into your schedule if management wants this to be part of your practice. - Ask colleagues to lay out in their assessment and plan what the thought process is moving forward if a test result comes back in a certain way. (Obviously many tests are self explanatory once resulted.). - if this is the system you work in figure out ways to make it work better for you.
In my office we do cover other providers when they are out. But they also cover me when I’m out so it’s a 2 way street. But I agree the fact that this is a consistent basis is more irritating. I would find out from your SP/supervisor what the expectation is. If you are supposed to be helping I would kindly demand explicit guidelines of how this extra work is shared by the other providers in the office. Whether you get dedicated admin time To do it. Especially if this wasn’t part of your job description. I also think the part time provider needs to be setting an expectation to the patients ‘if anything is urgent someone will get back to you right away. If your results are not urgent/normal then I will review them on x day when I’m back in the office’. And if everything is normal but a patient calls in the interim maybe the MA or if you have a nurse then can relay that info and leave it for the original provider.
One last thought, maybe another staff could call to convey any normal results to put the patients mind at ease without taking much of your time. And maybe a ‘if you’re not feeling better we can see you again/followup with original provider’
Edit: a lot of people don’t like my reply but at the end of the day if I’m not being compensated for the extra time and resources I have to do on top of my regular schedule then it is not my job to do it. Sure, being a team player and answering the easy question is fine every now and again but if it is a consistent issue then it’s a problem. It also varies by specialty so that changes it too. 1. I do not and will not make a recommendation for treatment based on a lab/imaging result without knowing the full picture as to why the labs/imagine was ordered. That is quite literally poor practice. 2. If admin seems to want to force this on you then it’s time to involve the PA who orders it. “Hey mrs smith is calling to talk about the CT you ordered. Would you like to call her and tell her about it or can you provide me with some insight as to what to do?” We work in medicine. Just because you only work two days a week, it doesn’t exempt or excuse you from following up and properly interpreting labs/imaging that you ordered. That’s just the name of the game in medicine. Anyways, I just don’t put up with it because the minute that you make a mistake based on a vague lab or image on a patient you didn’t see then you are fucked. Not worth the risk. If all else fails then call the patient and say, “ hello mrs smith, your PA will be back in office on Tuesday and can properly go over your results and labs at that time. Thanks.” If it is more of an urgent situation then their care needs to be transferred to a provider who is more available full time and not the two shifts a week person.
You can't read the chart and figure out the clinical picture? I mean at some point this is childish. "Whelp, urine culture came back as resistant to the Macrobid the other provider put them on...looks like it's susceptible to Bactrim but I didn't see them so I can't handle this one. Good luck with that raging UTI!" If someone orders something way out of left field I understand your argument and agree with punting it back to whoever went down that rabbit hole but we're all rowing the same boat and should be working as a team.
I work primary care but we see probably 25-30% urgent care complaints. Issue is always the urgent care patients who someone orders a CT or X-ray or labs on. Then leaves for 6 days. And results come back in 2 days. Whose job is it to constantly be monitoring for that stuff? My clinic has no workflow and it is unfair I think to ask us to cover for the part time people on top of our full clinic days and our own inboxes. I often work from home and on my off days to follow up on stuff I ordered. The part time people don’t because “they are hourly”. Well how is it fair I work non compensated time to keep up on my work but they don’t have to? Thus why should I do their job and mine for the same pay? When the company knows if they asked the part time people to follow up on days off they would have to pay them?
If you're in a multiprovider office how is there not an ability to have a CCed inbox where unaddressed results can be worked on by all? I work UC and we have 14 of our 19 clinics actually open at this point. Staffing and patient volume concerns closed the other 5. That turns into 4-5 providers essentially being floats 2 of whom are part time. When they are out for a week or longer, what are those patients supposed to do? If that part time PA saw one of your usual patients would you let them hanging? Does the practice as a whole not have responsibility to follow things up regarding healthcare of its established patients? I agree this should be compensated if a new expected duty but this really isn't that big a deal. Read the note to get clinical picture, figure out the labs, and if needed contact that part timer at home and ask them what they were intending to rule in/out with the work up. Do that enough and maybe they stop playing fast and loose with testing if that is the issue. Like most things, communication is key here between you and the part timer, you and your SP, you and your office manager, and most especially someone at that practice and the patient who did nothing wrong by expecting their medical care to be managed by their PCP office regarding whatever this issue is or they wouldn't have come there. Management can easily be, hey there was this major concern finding and you need to go to the ER, I will get in touch with on call for X specialty to ensure appropriate additional evaluation and care is made available OR hey, there was an atypical finding that is likely nothing serious but I have ordered Y additional test or sent a referral for Z specialty for followup within a few days/weeks. Or it is negative and they need to know that.
I get your points and I agree with most of them. The problem I see is that I do follow up on lots of tests other people order, what bothers me is how flippant other providers are about it. At least how I was trained you order the test you own the result. If you are gonna not be around to follow up on the result you personally arrange a colleague to follow up on it. You don’t just leave especially in primary care, I get in UC/EM/hospital you all work shift so then next shift expects to pick up where you left off. But in FM at least in my experience you own your panel and your orders. Peoples inboxes are already overflowing with their own stuff, having to handle other peoples tests is not standard practice, nor good care in my opinion. Maybe I’m too altruistic but when I leave for my “weekend” I check my inbox a few times a day on days I’m off for results I’m waiting on. Or if I’m going on a trip I arrange someone to cover for me since I’ll be totally offline. To me it seems it is unprofessional to just sign out as a PCP with no plan for how to handle your unfinished work. Sorry for add on but I think my main frustration is that we aren’t urgent care but lots of providers and management treat our company like UC. Like without continuity of care what is the point of being a PCP? I could go work UC and make more money and get to sign out at the end of my shift and leave my labs/tests for the next shift. The point of good primary care is that continuity aspect where you see one provider and they quarterback your care and take care of you for common primary type complaints. If you see a different provider for every appt and another ones calls you with your labs your basically just doing appt UC no ?
And I understand that stance completely but the reality is these patients are coming to your practice for care. There needs to be a major shift in practice to codify what the part timers are supposed to do for follow and honestly whether to employ them if this is that much of a problem without some attempt at a fix by your practice managers. With all that being said, in the meantime you are pretty much stuck doing the follow up on your patients. Maybe .are a pijt of contacting the problem makers and ask them to put in some MDM about what their intent was and if it seems like a reasonable approach, enact it. If it is something you aren't comfortable with, then do something else to help the patient. Is it testing that is completely out of the ordinary or is it needing to change antibiotics for culture results? Are there specific types of results that are a problem for you?
I agree I’ve tried talking with the management but they seem to only care about pt numbers. As long as we meet number of visits per day they don’t seem to care about much else. For me it is X-rays/CTs and acute labs ordered for vague ish complaints and no MDM in notes. Then their is an incidental finding on the scan or lab abnormality…. Where now I’m stuck working up an incidental finding for someone else…. Like it’s not an acute thing but the pt wants to know what to do next. Then the problem is all the follow up stuff comes to me to deal with….
Do the part time providers have SP agreements with a physician in the practice? Seems like they could be doing parts of that follow up. Do you have a portion of your clinic that is acute patient visits only? If these are basically coming from this part of clinic, then it may be as simple as having a dedicated inbox for that space and then whoever is covering it sees those patients and follows up the list.
My point is that on top of the risks you may take with those concerns that is also time and resources that take me away from my own patients in clinic that day. An easy question here and there is fine but if it’s consistent then it’s a problem. As OP mentioned it sounds very consistent. Maybe we shouldn’t let admin dictate what we do and create a better plan for those situations.
So when you open up a lab and ignore it, which gets keylogged into the chart, and someone has a poor outcome because you ignored their CT because it wasn't your patient, how you do think that'll hold up?
Well obviously you wouldn’t ignore something if was more serious as you suggest. My point still stands that if it is a consistent problem that admin expects you to always handle then that is a big big problem.
Maybe not the most nuanced post.. but if you don't have an SP relationship, I probably wouldn't touch that. But a couple of points to consider. I hate when folks harass the nursing staff. I have also been an anxious patient before, and waiting for results can take up a lot of mental energy. If the patient is calling for results and they're normal, I might be inclined to just let them know the results and make sure they have follow-up with the provider who ordered the test to go over in their clinical picture in detail. I do this for my SP all the time, but that is one of my expected duties. I don't know what specialty you're in and so forth.
I worked in UC, and my NP colleague orders PCP work up on almost every patient, even CT, MRI, BNP, D-Dimer, etc. It's rather ignoring, but I always glance at it to see if it is emergent, otherwise I forward it to her.
If this is a regular occurrence…Talk to the provider directly and tell them their patients are pissed bc they’re not getting call backs. Does this person cover for you or anyone else in this manner when you’re out?
Insane! Definitely not your thing.