Coordinating medical specialists at different hospitals
March 5, 2015 10:14 AM   Subscribe

After a terrible run of illness (and another PICU admission this week) we have seen a few different pediatric pulmonologists. The doctor we like the best doesn't have privileges at our hospital. How do we coordinate care?

We live in a major metropolitan area. We are located a few minutes from Suburban Tertiary Care Hospital (STCH) which has the only dedicated pediatric ER and pediatric intensive care unit in our neck of the woods. The next closest pediatric ER and pediatric intensive care unit are at Downtown MegaKidsHospital (DMKH), which is 45 minutes away. In a respiratory emergency, we really have no choice but to go to the emergency room at STCH. Overall, we are happy with the PICU care there. (Jesus H. Christ, never thought I'd be in a position to say that...)

However, STCH has two pediatric pulmonologists, Dr. McGruff and Dr. Nicer. Dr. McGruff is not a bad doctor, but we really do not get along with them. We have seen Dr. Nicer once as an outpatient, and then briefly in the PICU this last time, and were happier with them, but both times we've been in the hospital it's been Dr. McGruff's week on hospital service.

I elected to get a second opinion from Dr. Awesome, one of the pediatric pulmonologists at DMKH and I love her. She fits well with my scientifically-oriented mind, laying out the things we need to test now, what events would bump us up to the next tier of things to test for, what those would be, and what tests would be done. I like being able to see a few nodes down the decision tree, which I wasn't really getting from the other doctors. She also strongly encouraged us to contact her as minor issues arise so she can help us handle them at home, as opposed to "See us in clinic in a month" when there's a very good chance we won't make it that long without being back in the hospital.

So here's my dilemma: I want Dr. Awesome handling our outpatient care. I think she's our best shot at staying out of the hospital. But even she can't offer us a guarantee that we won't be back in the hospital, so we are likely to need to interact with Drs. McGruff and Nicer again. That means there is possibly something to be said for them knowing our child and what her care has been? I feel like it'll be a little weird if we've dumped them completely, but then again it's also weird to be seeing two pulmonologists at the same time.

Switching hospitals is not a real option because, again, in a respiratory emergency we aren't going downtown, the logistics would be a nightmare, and we might not see Dr. Awesome in the hospital anyway - DMKH has lots of pediatric pulmonologists.

I'm new to medical specialists, but this cannot possibly be an uncommon situation. How do we navigate this?

P.S. If you live in my area, have guessed which hospitals I'm talking about, and have any relevant personal knowledge, please MeMail me and we'll talk details.

P.P.S. Thanks to all who made suggestions in the last thread. They were very helpful.
posted by telepanda to Health & Fitness (4 answers total)
Absolutely pursue ongoing care with the physician who works best with you and your daughter. Like you said, having a good working relationship will hopefull mean that you won't be dealing with hospitalizations as frequently (or hopefully one day at all) down the road. Dr. Awesome can consult with the physicians wherever she is admitted. If you need her more specialized care, your daughter could also potentially be transferred to the other hospital once the acute crisis is over.

I hope you all have a much easier road going forward.
posted by goggie at 10:45 AM on March 5, 2015 [1 favorite]

Yeah, sticking with Dr Awesome as your primary doc makes perfect sense, and is probably something Drs Nicer & McGruff are used to. If you do need to go to STCH for an emergency, just ask them to consult with Dr Awesome and, if needed, try and arrange a transfer to DMKH (by getting in touch with Dr Awesome yourself) once it is medically feasible. You can also ask Dr Awesome at your next appointment about how best to coordinate any emergency care with the other docs.
posted by Rock Steady at 11:06 AM on March 5, 2015

Definitely go with Dr. Awesome. If Little Panda is admitted to STCH you can let Dr. McGruff and Dr. Nicer know who she sees and they can contact Dr. Awesome if they need anything. You can make this easier on everyone if the admission comes on a weekend or at night by making sure you have copies of the results from any tests that Little Panda gets (pulmonary function testing, CTs or x-rays, etc--not so much lab tests although if Dr. A does anything unusual like genetic testing or testing for cystic fibrosis, that would be good to have.) If Little Panda is hospitalized at STCH, make sure you get a copy of the discharge summary for Dr. Awesome so that she knows what happened in the hospital. It is surprisingly painful to get medical records from other big hospital systems, even ones in the same city, even when they're needed for patients hospitalized at other places.
posted by The Elusive Architeuthis at 11:48 AM on March 5, 2015 [1 favorite]

Yes, you don't need to be an official patient of either doctor at STCH for Dr. M and Dr. N to be familiar with her care.

Honestly if it were me, I'd just get a printed version of the physician's note from nano panda's chart each time she has a visit with Dr. Awesome and put it into a binder you bring with you to the hospital. That way they don't even need to request the records to be faxed. Whenever anything's happening with nano panda you call Dr. Awesome and she will advise you if you need to go in to the hospital or whether you can come to an office visit with her. And once nano panda is admitted whoever is caring for her should call Dr. Awesome to discuss the plan.

TEA makes a very important point above that you should also get copies of the discharge summaries to put into the same binder for when you do your post-admission follow ups with Dr. A. So basically, you're carrying paperwork from Dr. Awesome's office to make it accessible to the hospital, and you're carrying paperwork from the hospital to make it accessible to Dr. Awesome - it shouldn't have to be that way in this day and age of electronic medical records, but unfortunately, the systems don't talk to each other (yet), so it is what it is.
posted by treehorn+bunny at 5:48 PM on March 5, 2015 [4 favorites]

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