It happens all the Time

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She sat in a chair across from me as I sat down to start our visit.

“Did you get my records from the other doctors?” She asked

“No. Where did you go? I know you were going to the gastroenterologist.”

“Yes, I saw him and he sent me to the ENT. You didn’t get that note either?”

“No, I don’t have record of that.” I frantically typed a message to my nurse to get the records from these doctors.

She looked down, disgusted. “Did you get this?” she asked as she handed me an MRI report that I had not seen. I shook my head. “The doctor says I will need surgery.”

I noted the presence of an adrenal mass on the report. “That is nothing, by the way. They are present all the time.”

“I know. The orthopedist sent me to a urologist, and that’s what he said. I guess you didn’t get that report either.”

“No.” I sent another message to my nurse to get a note from these two doctors. I looked at her chart and noticed she needed cholesterol checked. “You are due for a cholesterol check.”

“My cardiologist just did one. He said it was OK.”

“Oh” I answered.

I typed one more note to my nurse.

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Sid Schwab

Whatever else may be true about the concept, this is a good argument in favor of EMR. In my former clinic, which is entirely over to it, the frustrations you describe wouldn't happen. Others would. But not those.
Rob

I actually did not catch the smart-ass-ness of your response. I agree that there is lots of need to communicate both ways. We have tried, but the specialists don't want to check e-mails even if it is to their benefit.
Ian Furst

didn't think my response through very well Rob -- posted a mea culpa over at my site with a link back -- re changing referral patterns - even though we've been early adopters of IT/EMR I've caused someone to change because of bad communication. specifically dropped emails (into spam/virus filters). It's tough to get it perfect especially when you are dealing with various digital/analog forms of communication. We get referrals by fax/email/letter/voice/voice mail (>13,000 per year). As far as I'm concerned the email is the best because it never leaves our EMR and we can see exactly how the referral was made and when. Any, sorry for the smart-ass response -- hopefully the post will make up for it. Ian.
www.waittimes.blogspot.com
Rob

Do you think a bank would ever miss a transaction withdrawn from another bank's ATM machine? Banks have a far more sophisticated information system. There is nothing of the sort in healthcare. IT is pathetic. Yes, Ian, EMR helps us in our own situation - quite a bit. At least I know that it isn't my staff that didn't file the consult yet. We are very efficient in getting things into the EMR and quick to add them when we know they are missing. We have changed our referral patterns, by the way, based on specialists' ability to communicate. This patient was exceptional in how many happened at once.
tiffany

Why does this happen? It is a world wide problem.
We have the same issues here, where the paediatrician is supposed to be co ordinating everything but the other specialists do not communicate properly. So when we go to the paed for follow up, we often know more than he does. Is it hard to send results?
Toni Brayer, MD

There are so many issues here, it is hard to know where to start. First the lack of coordination of care is the fault of the specialists who are ordering tests and sending the patient on to their friends. Then there is no report back to the primary care doctor so he can be even remotely informed of what is going on. Third there is the issue of wasteful tests without coordination. Finally there is the issue of the patient wanting some coordination or at least communication that is not going to happen! No wonder primary care is moribund. Talk about dissatisfying!
Ian Furst

I read the post and keep thinking about standing in front of patient, frantically reading the chart and telling the biospy came back normal. They say "I know, you told me two years ago". oops. EMR's going to solve all this -- right? :-)

BTW Dr. Rob -- if you feel it appropriate would you add me to you're blog roll?

Ian.
www.waittimes.blogspot.com
Dr. Smak

Ugh.

This post made my head hurt.

You forgot the part where she says, "The GI doc put me on Protonix, and he says that you need to get a prior authorization for me."

And the ironic thing is that I'm the one that feels guilty for wasting this patient's time and her insurance company's money, since I have nothing more to add.
Rob

Medical home would work if it was a partnership between businesses and doctors. If I go to a business and give them the opportunity to:
1. Keep their employees healthier through accountable prevention
2. Keep their costs down as the management of care would not include the insurance companies.
3. The doctors used medical technology so that patients did not have to leave work to get simple medical problems dealt with.

This would make businesses very happy and they would encourage their employees to use this. Employees would be empowered with more medical information and access than they have ever had. Finally, physicians would be happy because the businesses would pay them directly for this. It may sound like a stretch, but we are laying the foundation for such a venture. The only losers in this are the insurance companies (who are reduced to simply offer insurance), and those physicians who stay on the sinking ship the longest.
Dr. Val

I suspect that most patients will not comply with the medical home concept that is fundamental to the success of primary care and cost containment. What can we do?
Peggikaye

poor girl. Poor you. I know the feeling. I've given up. Seriously.