Blog | Wednesday, March 23, 2011

Primary care to specialists: We should talk more often


Whenever I refer a patient to a specialist, a copy of the patient's recent notes, labs and diagnostic tests is faxed to the specialist, in many cases, prior to their visit. And most of the time, after they see the specialist, I receive a fax back describing what happened.

You'd think this is standard procedure, but it doesn't happen as often as it should.

Abandonded Fax Machine by Abhisek Sarda via Flickr/Creative Commons licenseA study from the Archives of Internal Medicine, found that "That while more than 69% of primary-care physicians said they always or mostly passed on a patient's history and reason for a consultation to the consulting specialist, fewer than 35% of specialists reported always or mostly receiving that information."

The flip side is no better: "81% of specialists said that of course, they always or usually send consult results back to the referring primary-care doctor, but only 62% of those doctors said they got that info."

The lack of communication has the potential to affect patient care. It's important that a specialist know what had been done prior, lest duplicate tests are ordered. And I need to know what happened to my patient after he sees another doctor.

I found that specialists who still dictated their notes had the longest reply time. That only makes sense, since the added transcription step takes time. The solution, obviously, is better incorporation of health IT. I should be able to log into a patient's chart and see both my note and the specialist's note side by side. That's the way it works in the VA, which has a single, unified electronic health record system.

But the way we're doing it, with fragmented systems that don't talk to one another, is only marginally better than the old way of dictating a note, waiting for a transcription, then faxing it.

I anticipate the consolidation of practices, facilitated by health reform and impending accountable care organizations, to help as health IT systems are also amalgamated.

But that vision is pretty far away. Until then, primary care doctors and specialists need to make a concerted effort to communicate their office visits in a more timely manner.

This post by ACP Member Kevin Pho, MD, originally appeared on MedPage Today's KevinMD.com, social media's leading physician voice. Voted best medical blog in 2008, and with over 44,000 subscribers and 36,000 followers on Facebook and Twitter, KevinMD.com is the Web's definitive site for influential health commentary.