Phone numbers:
q Suite A: 4-1208
q Suite B: 4-1256
q Suite C: 4-1270
q Suite D: 5-0594
Thayer Secretary: Tanya Stamp: Patient line: 5-2817
Doctor only line: 5-4913
Janeway Secretary: Kerri MacDonald: Patient line 5-2834
Doctor only line: 5-4909
Fax number for the office: 5-1545
Patient Access Line (PAL) 5-6PAL
Express testing phone number: 5-1682
Express testing fax number: 4-1331
(Please include on the script you fax to them: Patient name and history number, your name and doctor’s code, what labs you want and for what date and clinic #141)
JHOC prescription line for med refills: 5-4939
Priority Partners Formulary Website: www.mdmahealthchoicerx.com
Andrea Milvid (social work): Office: 5-1102 Pager: 3-4525
Outpatient equipment needs or home care needs: Betty Sneed: pager 3-0614
Hopkins Homecare: 410-288-8100 fax: 410-282-8455
Referral Coordinator: 4-5971
Radiology Scheduling Line: 5-4100
Syphilis Registry: 410-396-4448 (state incarceration records: 410-767-6690)
TB Registry: 410-396-4444
Hopkins Hospital MA number 096751300
Hopkins UPIN number E85302
Helpful hints to manage your clinic…
Hint #1: Prepare for clinic.
q Check your schedule in advance on Venus.
q Look up the patients on your schedule in Venus to see what appts they’ve missed.
q Read at least the most recent few clinic notes, subspecialty notes and studies.
q Check out health maintenance: mammograms, colonoscopies, optho, etc.
q Make a check list of things you want to ask about and address this visit.
q Fill out known referrals, radiology recs, and direct access forms in advance.
Hint #2: Use your PAM list.
q To add stuff to the PAM list highlight it with the mouse and then right click. Once you have highlighted everything you wish to add just click store problems.
q Use the allergy list to keep track of important info… contact numbers, health maintenance, etc.
Hint #3: How to remember what to follow up and when.
q To do lists. It’s a good idea if you have a palm pilot that you carry with you. You could also keep it in a word file and store it on FESTER.
q Unsigned notes. Don’t sign your clinic notes until all the labs and studies have been resulted.
q jhed.jhmi.edu You can use the e-mail system to build
calendars as well as send you text pages to remind you of really important
things. Log into jhed.jhmi.edu Then on the my applications page choose
JHEM Calendar. You can create your own
calendar that is stored on the web in there.
You can also set up reminders. If you select new task, you just create
the task and then you can ask it to send you an e-mail or text page reminder of
the activity or event.
Hint #4: Use the clinic preceptors or your clinic advisor.
q These people are here to help you. Don’t sit there and struggle through something impossible. Just ask… its likely that they have had to deal with a similar situation before or know someone who has. They are a wealth of information.
Hint #5: Check out JHIMIPACE.
q On-line curriculum www.hopkinsilc.org
q There is a wealth of information in here and it’s really easy to use and accessible from any computer.
Hint #6: How do I call my patients?
q Beware of the caller ID. It seems all my patients have it. Many patients screen their calls and will call you back at the number the caller ID lists.
q If you are at home and need to call a patient… use the HAL line 955-9444 They can connect you to any outside line.
q Make sure you have a contact number for all your patients and keep it in your PAM list and update it with each visit.
Hint #7: How do I know what my patients are actually taking for medications?
q Have medication days. Ask patients to bring every prescription bottle, inhaler and OTC med. in their house with them to clinic. You might be surprised, alarmed, or both at what they are really taking.
q If the patient is with you, call the pharmacy where they get their scripts filled. Angela and Tanya have a ton of pharmacy phone numbers if you are having trouble finding the phone number for a pharmacy. The pharmacy can tell you what scripts are filled and when they were last filled to help you with testing compliance.
q Create a large font medication list for patients. Put on the list the drug name, dose, when to take it and what it is for. They really will love you for this.
Hint #8: How should patients get a hold of me for questions?
q The clinic secretaries are awesome and can do tons for you. Patients can call the secretary’s patient line and they will triage the urgency of the question. If something needs urgent attention you will get a text page. If it is something more FYI, you will get an e-mail.
q Questions are also fielded by Angela Dotson, our clinic nurse. She handles a lot of stuff for us during the day that we don’t get to hear about. Thank her!!!
q If they have questions after hours there is the PAL (Patient Access
Line).
955-6PAL The answering service will
page the primary care provider first and if you don’t answer will then forward
the call to the first or second jeopardy person. Please answer those calls if you can. When you are jeopardy you will appreciate it, since the primary
care provider can likely answer the questions the easiest.
Hint #9: How do things mailed to me at Hopkins find me?
q You have a mail folder in a filing cabinet between the 2 secretaries’ desks in JHOC. Check it every clinic visit. Check it at least one time per month when on unit rotations. Time sensitive papers will await you there as well as lab reports and radiology reports.
q Address: Johns Hopkins
Outpatient Center
Internal Medicine – 7th
floor
601 N. Caroline St.
Baltimore, MD 21287
Hint #10: What if I can’t fit everyone into my clinic that needs seen?
q If people need simple things (ie: BP checks, Diabetes med adjusting, COPD teaching) you can utilize Angela Dotson and Susan Arnold. Both can see patients in between doctor visits to help with these tasks.
q Look into the future when you know you are going to be on vacation or in the unit. You might be able to fill up those spots in your twice weekly clinics during case or consults and decompress your clinic backlog when you are away.
q Thayer and acute block exist. Try not to use them for routine stuff if you don’t have to. It’s hard on patients to be bounced around too much, but if someone needs seen for a semi-urgent issue, then that is what block is for.
q If you are really struggling, you can speak with Dr. Sisson about breaking up your new patient slots into 2 return slots for a month or 2 if you just can’t keep up with the needs of your clinic.
Hint #11: How do I admit someone?
q Believe it or not, some things just can’t be managed as an outpatient. If you see someone in clinic that needs to be admitted there are several steps to take:
o Call your ACS and make sure it is ok to admit the patient.
o Triage to see if they need to go to the ER or if they can go through admitting. Suggestion: if IV access is an issue or very ill send them via the ER
o If you are sending them to the ER: Call the ER attending and give them the heads up so that the things you are concerned about actually get addressed.
o Ask the nurse to call escort (5-5156) for patient transport.
o If not going through the ER, Call the shift coordinator (3-3989) to secure a bed and then call admitting at 5-5600 and tell them about the admission
o Call the likely admitting intern and give them a heads up.
o Stat dictate the clinic visit or manually type an unstructured note so that the admitting team knows what is going on.
Hint #12: What if my patient doesn’t have insurance?
q Send these people to see Andrea.
q The first thing you can do for them is fill out a 403b and see if they can get medical assistance.
q Make sure that your patients over the age of 65 apply for Medicare. Yes you need to apply!!!
q You can see your patients essentially for free. Just tell the check in desk in advance that you are not charging and they’ll have you sign a form waiving your fee.
q You can also bill for a 5 minute Level 1 visit which is much cheaper for patients.
Hint #13: What if my patient can’t afford / get their medications?
q Send these people to see Andrea. There are many programs which are helpful.
q Medbank has a decent formulary and the paperwork isn’t too time intensive.
q Pfizer has a discount program for people who have low incomes.
q People can qualify for pharmacy assistance even if they don’t have medical assistance.
q Use the sample closet if you fail with all of the above. There are some drugs that Angela and Susan keep locked up so ask about things you don’t see.
q Sometimes Angela gets coupons for drugs. Ask if you can’t get something.
q PP will pay for some OTC meds. See the handout or look in the formulary book.
q If a med isn’t on the PP formulary (www.mdmahealthchoicerx.com) fill out a precertification PP form with your justification.
q PP patients can’t have their prescriptions call in… you have to fax them to the pharmacy. Use the prescription fax forms that Angela or the secretaries have HIPAA compliant!!
Hint #14: What if my patients are missing a lot of appointments?
q No shows are a part of JHOC. Its not that you are a bad doctor.
q Tell Andrea about your frequent no show patients. If transportation is an issue, there are things that can be arranged.
q If the patient can’t make it to clinic consider the home visit program. Block sees 4 patients a month on home visits. People enrolled are followed vigilantly by Andrea and are seen regularly every 3 months.
o There is an LP clinic for things like R/O neurosyphilis or neurosarcoid LPs. There is a special requisition and the patient needs recent coags and head CT.
o You can order nerve conduction studies and EMG’s without a neuro consult by just filling out the requisition.
o Outpatient EEGs are also available.
q Psychiatry
o Patients need to self refer for psychiatry services for Priority Partners (PP). The phone number is 1-800-888-1965.
o There are walk in hours every morning at Community Psychiatry for people who need to be seen ASAP. They should show up at 8:00 AM.
o If you have someone who is suicidal in your clinic there is a STAT psych consult person that you can consult. I usually call the ER and let them know I have someone with suicidal or homicidal ideations and they will point you in the direction of whom to call. If they are combative call security for your safety and that of the staff.
o I recommend that if a patient has a psychiatrist and is on psych drugs that you have the psychiatrist writing the prescriptions so that there aren’t dozens of scripts for tricyclics being written, etc.
q Ophthalmology
o PP covers annual eye exams for people without co-morbid conditions each year without a referral. All they need to do is call Wilmer (5-5080) to set up an appointment.
o Write referrals for those patients with PP who have diabetes or hypertension so the ophthalmologist knows what they are looking for.
o If you have a diabetic, there is free diabetic eye screening at Wilmer. The patient can call 410-614-EYES.
o If you have patients who are having trouble affording glasses, refer them to Andrea Milvid. She has connections to get free / cheap glasses.
o
If people have acute eye issues you
can send them to the Wilmer ER 24 hours
a day.
q Audiology
o You can get audiology screening through the ENT department.
o
If your patient needs hearing aids and
can’t afford them we have a connection with the Hearing and Speech Agency 410-243-3800 x313 for super discounted
hearing aids. They can bring a hard
copy of audiology testing from here or get it done at that office.
q Dental
o PP covers dental!!! Get those teeth fixed. The phone number for patients to call to find accepting dentists is 1-800 698-9611.
o
If you have people who don’t have
insurance or have Medicare there is also the University of Maryland Dental
School who does dental work for reduced prices. Call 410-706-7102 for appointments.
q ENT
o ENT will follow your patients with trachs and help manage them.
o
ENT also will see your vertigo
patients and has a dedicated vertigo clinic
where they will perform audiology exams and treat vertigo
q Pulmonary
o PFTs are on JHOC 7. You can sometimes get same day spirometry if you ask nicely.
o Sarcoid patients can be seen in a dedicated sarcoid clinic.
o Pulmonary hypertension clinic is great. They can schedule outpatient right heart caths to assess pressures on your patients.
o
You can get sleep studies without a
pulmonary consult. There is a form to
fill out. If the patient has sleep
apnea though, you may have to then refer them to sleep clinic at Bayview to get
a CPAP machine and titration. This is a
new system and the kinks are just being worked out.
q Cardiology
o Be specific when you refer to cardiology what you are looking for.
o You can call the echo fellow in JHOC to try to get your patients echos same or next day if you really need it.
o Preventive cardiology can be good reinforcement for patients.
o Fellows clinic is your best bet for quick appointments and help with pre-op evaluations if you need to get cards involved.
o Use your firm faculty for muscle if you need it. Traill will always help out a Thayer resident and Kasper can pull strings for Janeway, etc.
o If you have a patient who needs a pacer or AICD, try paging the EP consult fellow at 3-3689 and getting some quick curbside advice. They can tell you the best way to get your patient a device or to whom to refer them.
o You can print out old EKGs in the cardiology area right past the play area on your left as you walk down the corridor. It’s the same MUSE system as in the ER.
o Cards clinic handles Holter and event monitoring. The reports will show up in your mailbox.
o
Coumadin clinic is also here. Call 5-3116 for appointments. There is a new patient referral form that
you will need to fax (4-1168) before
their first appointment.
q GI
o You can get sigmoidoscopies and colonoscopies without GI consults in your basically healthy patients needing screening. There is a form to fill out.
o If you can’t find PPI’s in the drug closet, Meyerhoff will often have them in their cabinet.
o
Hepatitis C can be sent either to GI
or to Mark Sulkowski in ID for management.
q Renal
o If you have someone with renal insufficiency consider sending them to renal clinic sooner rather than later. Its better to get to know them early than be scrambling when they eventually need HD.
o The renal team will take care of setting up outpatient dialysis spots and dialysis access if you refer them early.
o
Renal clinic will also administer
Epogen for CRI patients who need it.
q Endocrine
o For your complicated diabetics, endocrine referrals can be helpful. Anyone who is interested in an insulin pump should be followed by endocrine.
o There are diabetes teaching classes (1, 3, and 5 days) that are GREAT!!!
o The secretaries can help you get glucometers (pharmaquip form).
o The wait for appointments can be long. If you have a semi-urgent matter, I call the endocrine fellow for a curbside and often they can get your patients in more quickly.
o They can now do outpatient radioactive iodine ablations at JHOC through Dr. Ladenson.
o You can get outpatient endocrine tests through the infusion center (2-7944). They will do cortisol stim tests, etc.
o The infusion center also will also do pamidronate infusions if you need them.
o You can order direct assays for LDL if you have afternoon clinic patients who don’t want to come back for fasting AM labs.
o
Diabetic extra wide shoes can be
obtained at Van Dyke and Bacon in Towson.
They take Medicare too!!
410-433-1100
q Hematology
o Heme clinic will follow your patients with sickle cell anemia if you need help.
o They will take care of Epogen shots in those who need it.
o You can get B12 shots through Heme clinic or through Angela Dotson if you have B12 deficient patients.
o
You can get peripheral smears by
calling 5-3607 and setting it up.
q Rheumatology
o Refer to specific attendings if possible since they have favorites (see the list).
o
I have had the internal medicine/rheum
attendings help off the cuff with joint taps (shoulders and knees) in clinic
(ABIM procedure list).
q ID
o If you have patients with HIV, the Moore clinic has many resources if patients are interested in transferring their care.
o
I find Mark Sulkowski an amazing help
with treating Hep C. The patients get
great counseling and are followed well.
I’ve had great results.
q Dermatology
o Derm appointments can be hard to get… (ie 4-6 month wait)
q Oncology
o
Getting patients into oncology clinic
can be tough at first. You are usually
better off setting up the appointments yourself. It’s often helpful to call the oncology consult fellow to get assistance
in setting up new patient appointments for your clinic patients.
q OB/GYN
o GYN will perform many of your pap smears if you find that you don’t have enough time to keep up with this part of health maintenance. Don’t forget that you need to do 5 pelvic exams with wet mounts though to graduate.
o If you have someone who is pregnant and wants to terminate the pregnancy, I call GYN myself (5-5191) while they are with me in clinic. If you don’t, you may miss the window of opportunity for JHH and have to refer them to Bayview.
o
If you have patients without insurance
who need mammograms there are 2 resources to use. A) Under age 50 – Harbor Hospital 410-347-3378 or B)
Over age 50 – JHH Breast Center
5-4792
q General Surgery
o
If you have patients with wounds or
possible acute issues in clinic, find out if surgery ACS clinic is going
on. Often you can walk over there and
they will see your patient as an add on right then and there.
q Orthopaedics
o Ortho is divided up by joints, so you have to find out which surgeons do what parts of the body. I usually just ask the check out people who keep a list. Many things will need to be seen at Greenspring or other sites.
o
Ortho clinic is another place that
will often add patients on same day if you find out that they have resident
clinic going on. They often have no
shows and if you call and ask they will squeeze your patient in.
q Podiatry
o
There are now podiatry services at
JHH. You can send all your diabetics
here for semi-annual foot evaluations and maintenance.
q Urology
o Most of urology must go out to Bayview (except ACS clinic) If you have patients needing cystoscopy warn your patients they may have to go there for their appt.
o If you have patients with incontinence, there is a special clinic at Bayview in the Geriatric center dedicated to incontinence teaching and treatment to which you can refer patients.
o Urology will also follow your chronic suprapubic catheter / chronic foley patients and take care of catheter maintenance.
o
If you have patients with impotence
this is where I send patients as well.
q Neurosurgery
o
Often you need to fax your most recent
clinic note and the MRI results to get new patient appointments.
q Radiology
o If you have patients who need CXRs for pulmonary complaints, you can send them to the 4th floor with a requisition in hand and get quick turn around and even have the patient bring the film back up with them to you for a quick read.
o If you have something you need same day or next day, just call the techs. I have gotten same day lower extremity dopplers and CT scans when needed as well as next day brain MRIs.
o
If you need PET scans there is a
special form to fill out for the combo PET/CT.
The patient needs to have a normal glucose level the morning of the
test. Call 5-7226 for details.
q Weight management
o There is a nutritionist who can be very helpful with teaching not only your diabetic and hypertensive patients, but also your overweight patients.
o The weight management clinic at Greenspring is VERY difficult to get PP patients into. They will first do total liquid diet and then consider gastric bypass. There is first a long form that you need to fill out with the patient there as well as a full physical that needs to be performed before they will consider your patient for their clinic.
o
I’ve tried to set up a weight loss
support clinic at JHOC but the ball got dropped by PP. If anyone is interested in taking up that
torch, let me know.
q Anesthesia
o Anesthesia runs a pain management clinic and can help your patients with acute and chronic pain issues.
o
Specify acute or chronic pain
referral!!!
q Travel clinic
o If you or your patients are planning international travel, there is a travel clinic on the 8th floor who can get you up to date on vaccinations and prophylaxis you may need. (5-8932).
q Biopsies
o If you have lesions you need biopsied, there are several options. If you need CT or ultrasound guided biopsies you can set them up through Josie just like as an inpatient.
o
I’ve had success in the past with FNAs
of cysts in the breast center even same day and not even for breast lesions if
you call and they happen to not be busy.
q OT/PT/PMR
o OT is great for carpel tunnel braces.
o They are also helpful for paraplegic patients with splints and braces, etc.
o PT is very helpful for low back pain and regaining range of motion in injured joints.
o Don’t underestimate the power of the PMR referral for your paraplegic patients. They can get some amazing benefits with all these services combined.
o There is a specific referral for OT/PT that you need to fill out.
o
They also can perform cardiac and
pulmonary rehab.