Below is a friendly email exchange I had last week with with one of our hospital’s primary care providers:<\/p>\n
Dear Paul, do you know anything about whether pts should be given prophylactic antibiotics prior to dental procedures etc. if they have an indwelling IV catheter?\u00a0 I have a pt. who has a BardPort porta cath in her subclavian that was placed surgically for her chemo treatment about 2 years ago and she is doing well but asked me this question and I could not find an answer.
\nThanks
\nCathy<\/p>\n
Hi Cathy,
\nIt is not formally recommended; and in this virulent C diff era, I wouldn’t do it.\u00a0 But some oncologists still recommend\u00a0prophylaxis (and\/or some patients really want it), so if they insist, I suggest you use the endocarditis prevention guidelines.Regards, Paul<\/p>\n
Thanks much, very helpful.\u00a0 Cathy<\/p>\n
According to the Allied Physicians Salary Survey<\/a>, the average salary of an Infectious Diseases Specialist with at least 3 years experience is $178,000\/year. If we assume a fifty-hour work-week (ha), with 4 weeks for vacation, that comes to an hourly rate of $74\/hour, or $1.24\/minute.<\/p>\n The time it took me to read the email, type a response, then open her gracious note of thanks (note to curbsiders\u00a0 — we like<\/em> being thanked) was all of\u00a0around\u00a05 minutes. Applying the above hourly rate, we find the email curbside consultation was worth approximately … 6 dollars.<\/p>\n In other words, for what a curbside consult “costs”, you could get a gallon of gas and a cup of coffee at your nearby Quik Mart.<\/a> But not much more.<\/p>\n But is that really all a curbside consult is worth? Didn’t my response also save the primary care provider some time? The patient a potentially severe (and costly) adverse effect (C difficile<\/em> colitis — very scary these days)? What about the training and experience required to to answer the question authoritatively?\u00a0 Or the time it took away from other critically important activities? <\/a><\/p>\n Sure, I’ve been asked this question before (so it was kind of a slam dunk, to invoke the currently appropriate Boston sports metaphor), but isn’t that why we pay the experienced neurosurgeon his\/her $500K+ a year?\u00a0 Because they’ve done\u00a0brain surgery\u00a0before?<\/p>\n The sad fact (for us ID doctors, at least)\u00a0is that curbside consultations don’t fit into any reimbursement model for health care.\u00a0 And by the way, the “price” for a curbside consult isn’t even\u00a0$6 — it’s $0.<\/p>\n","protected":false},"excerpt":{"rendered":" Below is a friendly email exchange I had last week with with one of our hospital’s primary care providers: Dear Paul, do you know anything about whether pts should be given prophylactic antibiotics prior to dental procedures etc. if they have an indwelling IV catheter?\u00a0 I have a pt. who has a BardPort porta cath […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8,9],"tags":[],"class_list":["post-23","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","category-policy"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/23","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=23"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/23\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=23"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=23"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=23"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}