Op-ed: What we have in health care today is a failure to communicate

The following op-ed was published on May 4th, 2008 in the Nashua Telegraph.

Communication in medicine grows worse by the day. What should be a pillar of quality health care is instead a resounding failure.

Patients are rushed through office visits and often leave without having their questions answered. Labyrinthine barriers have to be overcome before speaking with a physician. Reaching a medical provider via the Internet is an impossibly daunting task. Doctors rarely talk to each other to coordinate treatment plans.

With appointments packing schedules in 15-minute increments, physicians report there is not enough time to conduct an appropriate office visit. This is to the patient’s detriment, as studies show that the public adequately understands their doctor’s instructions only half of the time. In today’s digital age, one should ideally be able to e-mail or instant message their providers to ask follow-up questions.

This infrequently happens, as Medicare and private insurers rarely pay for electronic communication. A physician who repeatedly handles patient requests outside of an office visit will lose money, contributing to the reluctance of the medical community to embrace the Internet.

This is unfortunate, as judiciously utilizing “virtual” Internet-based visits and secure e-mail can both increase patient satisfaction and reduce health care costs.

Communication between medical providers, or coordination of care, is similarly uncompensated and devalued. It shows.

The New England Journal of Medicine reported that specialists and primary care physicians are not satisfied with the information they send to each other. Emergency departments sometimes treat patients without accompanying medical information. The time it takes a primary care physician to receive a specialist’s report can exceed a month.

It seems counterproductive that physicians have such a hard time talking to each other when the system is becoming increasingly fragmented. Consider that the average Medicare patient sees seven different doctors annually. Combined with the advent of “hospitalists,” or doctors who only practice inpatient medicine, the days where a single physician who cared for a patient from the office to the hospital and back are fading.

Nashua is fortunate that both St. Joseph Hospital and Southern New Hampshire Medical Center have established hospitalist programs that communicate well with primary care physicians. This, however, goes against the national trend that finds clear and comprehensive information exchange between hospitals and outpatient medical offices to be lacking.

Universal electronic health records are an optimal solution to address these issues and have been shown to decrease the incidence of medical errors arising from miscommunication. However, the short-term costs of adopting electronic records are steep.

Physicians pay for startup costs that can exceed $20,000 per doctor and find much of the return on investment goes to the insurance companies or the government. This is a major reason why only a quarter of physicians’ offices nationwide have implemented such systems.

How can we improve this glaring failure to communicate?

We must change the incentives within the health-care system. Instead of the current reimbursement system encouraging doctors to maximize the number of office visits and procedures performed, pay them for spending time with patients and coordinating care with other medical providers.

It is also imperative that electronic records be adopted, thereby reducing medical errors and facilitating the transfer of health information. The government and medical insurers need to provide the financial resources for doctors to make this critical leap forward.

As for patients, be aware of the difficulties physicians face when trying to talk to one another. Know your medications and medical history when seeing a new specialist or receiving care in the emergency room. Ensure that any new treatment recommendations are appropriately communicated with your primary care physician.

Our health care system has plenty of room for improvement. Simply making it easier for medical providers to talk to both patients and each other would represent a significant step in the right direction.

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  • Onehealthpro

    Hooray! Great ideas. I spend a great deal of time maintaining copies of medical records for my aging parents because the various offices involved frequently lose the information provided.
    Onehealthpro

  • Anonymous

    I agree that this is a tremendous problem. Just read through the comments on the last 2 posts and you will see how wide that divide is!

  • Anonymous

    I take issue with your mention that EMR’s reduce medical errors. Best as I can tell from what data exists, it may reduce some and create others.

  • Anonymous

    Your EMR can’t talk to my EMR.

    Electronic records don’t help. What they do is make long, unreadible notes that are easy to bill from. These same long, unreadible notes often convey minimal (if any) unseful clinical information.

    Communication is much more difficult and care is more fragmented than ever. You’re solution (changing the incentives) would work and solve a lot of problems.

    Let me bill for talking to a pt’s PCP, nephrologist, oncologist and family. I’ll make sure t get it done and documented.

  • Anonymous

    http://www.bmj.com/cgi/content/full/337/jul04_1/ a664

    I hope you’ll enjoy seeing that the problem is bad in UK as well.

    If you think 10-15 minutes is quick per patient try UK medicine where anything over ten minutes a patient is considered extravagant.

    Bad communication is endemic in UK NHS.

  • AngryYoungMrs

    As a young Finnish GP-to-be, I¨d rather give a patient 30 minutes or more, see them leaving satisfied and meet them again in six months or a year than 8 minutes per head and have them either come back to me or visit the ER after a week. But alas, it is seen as more “efficient” and “cost-effective” to have dissatisfied patients. Fast food is sloppy and unhealthy nutrition, why on earth go Fast healthcare?

  • disgusted

    Is it me? I have wonderful doctors but it seems that some of their staff members don’t communicate with them much! Does anyone else seem to have this problem?