Orthopedic Surgeon Reacts to Dr. Glaucomflecken - Ortho Admits Patient to Medicine

In this video, Dr. Webb reacts to Dr. Glaucomflecken - Ortho Admits Patient to Medicine

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Antonio J. Webb, MD
Orthopedic Spine Surgeon
South Texas Spinal Clinic
9150 Huebner Road Suite 290
San Antonio, Texas 78240
Office: 210-614-6432
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[maureencameron]

Internal medicine here. I am happy to see orthopedic patients who need a pre-operative cardiac risk assessment, or who develop post operative complications such as chest pain, infection etc. Please, by all means, call for a consult. What is frustrating is the culture that generally accepts that ortho can't manage even the most basic of admissions/orders/discharges, and all of that 'scut work' gets turfed to the internist. I'm sorry, but if you went to medical school, you can write up some admission orders and handle a discharge summary. Furthermore, if ortho has a patient who develops chest pain, for example, is it too much to ask that you order an ECG prior to calling IM? There are some medical basics that we should all be able to handle, particularly in an urgent situation. Internists want to help, and we definitely want what's best for the patient, but sometimes I feel like our services are abused/taken for granted.

[TomBridgeWells]

In my experience the only time an issue arises is when surgical teams try to 'dump' a patient for a well managed condition like diabetes - if there is an acute issue (DKA, HSS etc) by all means refer, but a patient merely HAVING diabetes is not a reason for a surgical team to not take care of them

[andymarsal]

I strongly agree, being "ortho" myself. Love the argument about not letting your grandmother's blood sugar be taken care of by ortho. Not letting an internal doc take care of fractures...

[jinijinxer]

My Grandma really did win the jackpot then, her two sons are Drs, one in Internal Medicine & another in Orthopedic Surgery just like you. Best part is all her most nagging needs are taken care by these two along with Ortho's wife, anesthesiologist.

[bigsword]

So as an IM doc finishing up residency, I agree with the core of your argument, but it ignores the existence of consulting teams. HMS consult teams exist literally for this reason - to help manage patients with primarily orthopedic admissions. When you ask the ED to admit a patient to medicine who is being hospitalized for a hip fracture, unless they are genuinely very medically complex (ESRD, HFrEF, very labile DM, etc.), it doesn't make sense to admit to IM. The IM docs are forced to stand around waiting for the orthopedic attending to finally give the OK for literally every step of the hospitalization, including discharge. It makes it feel like IM is forced into becoming your secretary for discharge summaries and H&Ps, and it really breeds this malignant culture where IM feels genuinely used and abused. I think that the lack of use of consult HMS services (where back in the day you'd just consult the patient's PCP) has really helped facilitate the culture you're joking about.

[OstblockLatina]

Just wanted to take the chance to say a spine surgeon saved me from paralysis from the waist down when I was 22 and I love and would die for you people. Keep up the awesome work, you guys are heroes.

[what_the_duckk]

“It’s just a misunderstanding” 😂

P.s. I’m a rising 4th year med student in his 30’s and you were an early part of the reason I never gave up on getting into med school! Just want to give you your flowers and say I appreciate your content! Been following you since your early days

[DrEsky]

"just continue the most important three medications and convert the rest to Ancef". LOL!! No, really, as a specialist in Internal medicine I respect and honor the skills of my Ortho colleagues and am happy to care for the medical issues of their patients! One big happy family, ortho bro!

[SoullesGinger]

I'm a motorcyclist/racer, Ortho is my primary care physician.

[parthu]

Ortho primary, medicine on consult. Done. Not fair to medicine to become the primary when the primary diagnosis for admission is purely orthopedic.

[johnnypeck]

Dr. Webb, your videos really are they best. They provide me with a source of humor and information. You really are pulling back the curtain to what being a doctor means in the best way possible. Thanks ❤️

[tal]

Dr. Webb, Just wanted to thank you for all the videos you've made over the past years. I was admitted to med school in the past couple months, and I have to say there were many lows throughout the journey and watching your videos definitely helped me push through! On to the next push...

[sav]

I agree to an extent. If I was a hospitalist, it would be frustrating that that the doctor that's only fixing 1 issue (let's say hip fracture) makes more money than the doctor that winds up managing the patient's numerous co-morbidities, writing the orders, answering the pages, doing the daily progress note, working with the social worker to figure out placement (cause unfortunatley grandmas with htn, dm, afib on eliquis always fall and can no longer live alone), etc. Yes, the surgeon will see the patient for follow up (unless they just have a PA or NP see post-op patient which I know some that do) but they also add a new patient to their roster who potentially might need another surgery in the future. I think medicine as a whole would benefit a lot more from everyone doing like a mixed intern year. Surgeons need to live the IM life for a little and IM needs to live the surgery life for a litte... beyond med school. That's why anesthesiology is nice, we have to see each side. Everyone is medicine is working really hard, but working really hard making >$500k a year is a lot different than working really hard making $300k a year and I don't believe variance in years of training and percieved or actual "risk" associated with a speciality fully justify the desparity in pay... a surgeon doing elective hips will make more money than a doctor treating a patient's decompensated heart failure, but only one of these is really a threat to your life. And I say this knowing full well that there are way way way more people working really hard making <$50k a year.

[Elizabethogunsanya]

ER Doc here! We all went to med school and had to take step so managing htn or stable diabetes isn't rocket science. Your subI could do it. I would "rather" not take of the combative ED patient but I can't just pawn it off to psych. The culture needs to change.

[flynnkay]

You're such an admirable sympathetic guy I hope you have nothing but success in life! :)
Watching your videos because I am considering studying medicine

[VioletteToussaint]

"That was hilarious" ---> absolute poker face

[Gnv-qm]

As a psych registrar in the 90s I remember Ortho referring an unconscious patient who had jumped from a building and was rigged up in all sorts of ropes and pulleys. Of course the patient couldn’t be admitted to our emergency unit. We would assess the mental state and provide support once the patient was awake. There was no risk of a repeat suicide attempt in that state.
I work in private practice now as a Child and Adolescent psychiatrist and Consultation Liaison services are an absolute pleasure with clear roles and communication. I guess we have all grown up and learnt a lot.

[Uhlbelk]

The difference is, internal medicine consults ortho, when there is an ortho problem. Ortho dumps patients onto internal medicine when there is no internal medicine problem. If grandma is on her home diabetes medications and does not have an AKI, or DKA, it doesn't take a specialist to continue home medications.

[ljerry]

Dr. Webb-you are too young to have missed out on the ortho docs from the late 80s to 90s in medium sized hospital. Consult the patient’s primary care or on call IM 100%. Fun times! Heck back in my early days back pain got pelvis c traction & PT twice a day. Yikes!

[LenaFerrari]

Agreed. We have different specialists for different issues for a reason. I wouldn't want a orthopedic surgeon to manage my diabetes, however I wouldn't want a endocrinologist to operate my broken leg. And I could have both.
That said, there's something hilarious about my orthopedic/trauma surgeon dad, who obviously went to med school, freaking out when I had food poisoning and threw up, because my step mother (pediatrician) wouldn't pick up the phone and tell him what to do