I divide them up into two groups. The first are the patients that are quite ill and scared as they have waited too long to get medical help and are afraid things will not turn out well. They generally tend to come in later in the day, especially on Friday or Saturday morning at the office. Friday, I can send them to the hospital lab for blood then have the lab page me with the results so I can call the patient at home.
For radiology, I call the department and ask that the films be read and have a report called to me. I advise the patients the hospital will charge more for the services when done this way. I also tell them that they should not hesitate to go to the ER, as these labs and x-rays can be done there and a decision on treatment can be made immediately based on the results.
The second group are the patients with an aggressive personality who want everything done right this minute, even if it is not an emergency. I give them the x-ray and lab slips and tell them to go immediately to the hospital.
It's funny how they change when they're informed that the hospital will be charging more for the tests, as their insurance may not cover as it is not an emergency. Referral is made to the specialist and I give them the number for the physician's office so that they can call concerning the appointment.
Since almost all the specialists are hospital employees, referrals can take weeks to months for the patients to be seen. They can get on a cancellation list, but the appointment will be at the convenience of that office. Lastly, I recommend the ER but explain that the waiting time until seen can be several hours.
When they call back demanding things I also recommend they call their insurance company so that I can make an out of town referral to a regional center for evaluation of the problem. Again they are welcome to call the center and demand an immediate appointment.
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