My experience as a government employee led me to an epiphany today!
As a working physician, when I want a patient to get a non-urgent consultation, I fill out a request to send to our medical director. There the request is reviewed, and held up to diagnostic criteria to see if the request should be denied or upheld. It’s a cost-saving measure, and ideally should help us working physicians to better manage our own patients more effectively. But in practice, it can be a game of guessing and second guessing to try to get the request approved.
This week the medical director was on vacation, so I was asked to go to the main office, and review outstanding consultation requests, to approve or deny. At the main office, we actually have copies of the diagnostic criteria used to make the “approve or deny” decision. These had been withheld from the physicians actually doing the work as the volumes containing the info are expensive, and it would be a copyright infringement to just photocopy them and distribute them to us working docs.
The standing joke among my staff was that I was going to the head office to approve my own requests.
I plowed thru about 20 referral requests, using the criteria and medical knowledge to either approve or deny my colleague’s requests for consultations.
I got to the second-to-last one. It was from me! But now I had the diagnostic criteria in front of me! I’d covered 4 of the 5 pre-requisite points to justify a consult, but I’d missed one!
So I was forced to deny my own request, and send it back to me, with directions for further testing and resubmission after that was complete.