After weeks of a quiet Flownet, funny when something dear to our 
     hearts comes across, everyone wants to jump in. As I was mentioned in 
     the call rebuttal, I feel obliged to comment. What Joanne doesn't know 
     is that things changed, the gauntlet thrown down, so to speak, and her 
     call rotation starts this Friday night at 6 PM.  I feel some guilt 
     (albeit very little) about not doing call and we have taken some 
     serious flak regarding it. We went to weekends a few years ago in 
     response to demands for increased coverage. Our Medical Director has 
     been quite strong in his support of our not being on call and he has 
     taken a significant amount of heat as well. How long we can hold out 
     on this issue remains to be seen. I truly believe that this is 
     primarily a legal issue and only secondarily, a medical issue. While I 
     can appreciate the legal implications, I am unwilling to give up my 
     personal life to protect someone's legal liability. I, as I am sure 
     most of us, would be glad to come in for medical reasons. The trouble 
     of course, is separating the two.
     
     How do we deal with this dilemma? The key of course is education. 
     Despite the published idea that clinical diagnosis is unreliable, Phil 
     Bendick recently told me that in his lab, RVT's are correct in their 
     clinical dx >90% of the time! In their lab, the ER docs improved from 
     a dismal % to greater than 75% of the time. Needless to say, this also 
     goes a long way towards cost efficient medicine as well.
     
     At this hospital for example, we perform a venous study for most of 
     the patients presenting for cellulitis, despite my attempts at 
     education of the physicians. At the SVT conference, Cindy Burnham 
     presented a paper outlining how they dealt with the problem. 
     Basically, it was a somewhat convoluted pathway that involved going 
     through several physicians in order to get a study after hours, unless 
     the patient met certain criteria. It also required the ordering MD to 
     fill out a questionnaire regarding the patient's history and reasoning 
     behind a test that could not wait for a few hours. This was used to 
     then provide feedback to the physicians. It was successful in 
     significantly reducing the # of calls. I would recommend looking for 
     this when it comes out in JVT in the near future. Clearly, in addition 
     to this recent study, there are numerous others studies that indicate 
     successful screening of patients that will most benefit from vascular 
     lab evaluation can be accomplished.
     
     A successful policy regarding call that will serve the patient and be 
     fair to the technologists is possible, BUT, it takes planning, effort, 
     and A STRONG, SUPPORTIVE MEDICAL DIRECTOR, that can and will take some 
     heat for the lab. If it comes to that, I'll let you know what we 
     do.... until that time, I'm going sailing! BTW - Just kidding Joanne
     
     Bill - Venice, Florida