I will share with readers a recent occurrence between me and another doctor that was both rare and refreshing. I was serving as the gastrointestinal consultant on one of the doctor’s patients. I performed a scope examination of the stomach and obtained some routine biopsy specimens. The pathology results were abnormal, but benign. No urgent action was needed, but a full airing of the significance of the results would require a conversation between me and the patient in an office visit. I notified the patient that there was no medical threat at all and we would unpack it all during his next visit.
The referring physician wondered about this delay, which
perhaps is a different style from other gastroenterologists (GI’s) who he works
with. (My guess is that other GI’s may
opt to handle the issue with the patient on the phone or via the portal. I
think, however, that there’s too much complexity to fully address this issue in
this manner.) So, here’s what the referring doctor did. He called me.
I was delighted to hear from him and have an opportunity to have a real
time dialogue about a patient we shared.
Before even entering into the substance of the issue, I told the doctor
how rare it is to have such a conversation which always ends up benefiting the
patient. After our conversation, the
doctor completely understood my point of view.
I promised to keep him informed after the patient and I met in the office,
and I did.
I rarely receive direct communications from referring
medical professionals who are referring patients to me. Yes, I can usually
deduce the reason for the visit from either the patient or the beloved
electronic medical record (EMR). This
can be challenging. The consultation
request may be buried in the EMR months ago requiring some high level sleuthing
on my part. And more often than you
would think, patients do not always know why they are seeing me. And the EMR is not always clear. The record may indicate that the patient is
being sent for a screening colonoscopy but the patient also has abdominal distress. Does the referring doctor want me only to do
the screening procedure or to evaluate the patient’s symptoms?
Of course, we physicians and medical professionals do
communicate via the electronic medical record regularly.
But this method has obvious limitations.
I send an electronic message to a doctor. I may not hear back for a day or two. Or the doctor may be on vacation. The doctor’s response may not fully address my concern so I send another message. This can become frustrating and
inefficient. And doctors today are
busier than ever and busier than we should be so we tend to be very clipped in
our communications which has obvious drawbacks.
And let’s face it. If a doctor
calls me on the phone, the likelihood is that I will be available at that moment
is quite low – a disincentive for initiating actual conversations.
Actual conversations between medical professionals is clearly
optimal In one conversation, the course of a patient’s treatment can radically
change for the better. For instance, I
may favor surgery for a patient, but back off after having a dialogue with the
surgeon who convinces me otherwise. This
can’t be replicated with a voice mail or succinct e-mail.
I’m sure most doctors would agree on the value of conversations among colleagues. This is how medical care used to be conducted. Why has this become an anachronism? There are two reasons. Electronic communications have taken over the communications realm in medicine and beyond. And physicians who are overstretched simply don’t have the time to reach out regularly with colleagues. Efficiency wins over quality. But guess who really loses out the most here?
Former PCP here. You are absolutely right. Nuances in a person-to-person dialogue between docs cannot be captured in "the portal". The pressure to use Epic as a communication tool between physicians is one of many things that "burned me out." Prior to Epic, during the era of paper charts, we saw more patients, and did a better job of communicating with them AND with each other. And may I add, I'd received referral letters from you, Dr. Kirsch; they were excellent, very informative. Thank you.
ReplyDeleteMy father, who is an attorney, says he is amazed at how little communication there is between doctors caring for a patient, and believes that this often results in sub-optimal care. And this type scenario played out when my mother was recently admitted for A-fib, which of course was on a Friday so that there was cross-coverage by Cardiology and Hospitalist over the weekend. It was an absolute fiasco.
ReplyDeleteFM here and thanks for this perspective. It’s nice to have colleagues I can call with specific questions about patients prior to or after referral. I especially like hearing back from the specialists, whether by letter or direct communication. I like reading the assessment and plan as I usually learn something new. What’s helpful too is getting the H&P’s and discharge summaries from a tertiary care hospital in real time, so I’m not totally relying in the patient’s recall when they come for hospital follow up.
ReplyDeleteAs corporate entities take over practices and hospitals, some colleagues have been told by the bean counters not to call
ReplyDeleteanyone — it’s not billable and thus is viewed as lost time.
Thx to all. While we all lament the absence of regular conversations between practitioners, we understand the realities that are responsible for this. I presume that with the emergence of AI that human to human communications will approach extinction. Electronic medical record systems - excellent tool for coders and billers - have delivered great advantages to caregivers and patients, but there has been a cost which all of us bear every day.
ReplyDelete