There's a remarkably dumb rule here that if you want to discharge a patient to an inpatient rehab facility (IPR), you have to order a Physical Medicine and Rehabilitation (PM&R) consult. I have no idea why that is because i know for a fact it is not a national rule.
Me: Ortho res returning a page
Case Manager: Hi, I'm calling about your patient in room 987, Ms. Jones. Physical therapy is recommending she go to IPR, so you need to call a PM&R consult.
Me: She had a hemipelvectomy. She can't get out of bed without two people helping her. I don't think she's going to be able to do inpatient rehab since usually you have to be able to do about 4 hours of therapy or so.
Case Manager: Physical therapy thinks she can do it
Me: But she doesn't want to go to rehab. She wants to go to a nursing home. She has about 6 months left to live.
Case Manager: You need to call a PM&R consult so I can get started with discharge planning to get her to a rehab facility
Me: I don't understand why I need to do that.
So I did and the PM&R doc said that not only would the patient not qualify for IPR, but, uh, she didn't want to go.
I figured the issue was put to rest, but I got paged again today:
Me: Ortho res returning a page
Case Manager: I'm calling about your patient in room 999, Ms. Smith. Physical therapy said she needs to go to a rehab facility, so you need to put in a consult for PM&R so I can get started on that.
Me: She's supposed to go home later today.
Case Manager: No, physical therapy said she needs rehab. So put in the consult.
Me: I spoke to her this morning and she feels very comfortable going home
Case Manager: I just spoke to her and she agrees she needs rehab. You need to put in a consult.
So I went to talk to the patient and she said that no, she didn't need rehab. She wanted physical therapy (fair enough), but she felt safe going home and didn't want to go to a rehab facility. Which I agree with. Except then I had the case manager and the physical therapist breathing down my neck until I finally ordered the stupid PM&R consult in the hopes that the PM&R doc would be more successful than me in convincing everyone that she didn't need it.
I really hate calling stupid consults. Mostly because I hate when people call me for stupid consults so I can sympathize with that one and I try not to do it. I'm not saying I've never called a stupid consult, but usually when I do it it's because my attending is making me. And it is really a waste of another doctor's time if I have to call a consult to get the case manager to stop telling me what to do.
Also, physical therapy and I do not always get along. They usually make discharge recommendations and that's fine, they see the patient mobilize more than I do, but sometimes I feel like they overstep their boundaries. Which is fine because sometimes I feel like everyone oversteps their boundaries, including me. And when I do it, I justify that i"m doing it in the best interest of the patient, which is probably how everyone justifies doing it, so whoever uses that argument generally wins the war. (just like the first person to say he/she is not comfortable doing something wins that war) Also, the physical therapists kind of hate me over at one of the hospitals because we got into, shall we say, a disagreement over a patient. They didn't think he was safe to go home, I personally walked him around the second floor with a walker and made him demonstrate foot-over-foot, pivot, stand to sit, sit to stand, off and on a toilet, and stairs...and then I decided he was safe to discharge and discharged him. They didn't like that one too much. And it was a case of me totally overstepping my boundaries. Which was, of course, in the patient's best interest (long story), but OK, I can see why they wouldn't be too impressed with that one.