Primary care doctors and specialists need to better communicate

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.

A study from the Archives of Internal Medicine (via the WSJ’s Health Blog), 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.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.medicalvirtualassistants.com Daniel McKennitt

    Hi Kevin,

    I definitly agree and in fact in our clinic we are set up in a primary care network where we are electronically connected with the specialists in our network, so we can actually send them the patient demographics, patient history and reason for consult all electronically as all too often ‘We never received the fax’ had been a problem. Additionally, we have a virtual medical office assistant follow up on all our consults to ensure they have been received and follow up with the specialist if a report has not been sent back within one week of seeing the patient. It works well in our network.

  • http://secondbasedispatch.com Jackie Fox

    Great post–this can only help patient care. I just want to chime in with a supporting story. My oncologist told me recently how good my family doctor is about sharing info and how rare that is. He said in his experience it’s pretty one-sided and that the specialist is usually the one sharing information with the primary care provider.

  • jsmith

    We track all referrals and we have a person part of whose job it is to bug consultants if we don’t get a reply back in a timely manner. This seems to work well for us.
    This is a huge quality of care issue.

  • Justin

    I say give patients the records to take to the consult appointment with a clear reason for the consult amongst the paperwork. Seeing patients in consult with only a diagnosis on a sheet, no specific question or concern, and no records leads to significant guess work on the consultant’s part; not to mention it makes the consultant and PCP appear wanting in the eyes of the patient when I have to ask, “Why did Dr._____ send you to see me? The question of whether the PCP wanted a single consult visit or wanted me to takeover care for a specific diagnosis is a huge question as well. And calling primary doctor’s offices for records to be faxed leads to a frustrating loop of answering machines and messages left.

    I think patient’s are responsible enough to be entrusted with their own health records. Why rely on a fax machine and a broken system?

  • pcp

    “We track all referrals and we have a person part of whose job it is to bug consultants if we don’t get a reply back in a timely manner. This seems to work well for us.”

    Same for us. Any doc, primary care or sub-specialist, who is too lazy to ask his staff to get the needed info, is going to be too lazy to read another doc’s note in the EMR.

  • http://www.chrisranjana.com software company

    Lack of communication between members of the health care team has always been a problem in the medical field. That too if it from one doctor to another, imagine the stand.
    But the doctors can also be not blamed, they are too busy to spend their time faxing information to other doctors. Hope with the use of electronic health records such problems get solved and doctors be able to communicate better.

  • http://www.littlepatientbigdoctor.com Haleh Rabizadeh Resnick

    How right you are- what’s happened perhaps is that the high degree of specialization puts the primary doctor in the dark when reading the specialist’s reports. That is probably why so few of them read it. My primary has read the reports and actually turned to me- the patient and not a doctor- and asked me what it means. Imagine what it’s like for patients, without a medical degree to understand what is happening. Primary doctors need to go beyond their comfort zone – that will allow them to become key in helping their patients.

  • http://myheartsisters.org/2011/01/13/stupid-things-doctors-say-heart-patients/ Carolyn Thomas

    Excellent points, Dr. Kevin. But I believe it’s up to the patient as well to be vigilant about all test results and consultant’s reports, and to ALWAYS ask about/discuss those reports at each office visit to confirm that, yes indeed, that letter from the specialist is now in our files where it belongs. AND, as Haleh correctly points out, that our docs actually understand it.

    Communication – or miscommunication – is usually where all kinds of important things fall apart, in life as in the doctor’s office. Communication between doctors is but one ingredient.

    Of far greater import to me is how doctors speak to their patients, always a topic of heated discussion among patients. (Oh, doctors, if you only knew….!)

    Recently, I interviewed dozens of heart patients asking them about their “best” examples of stupid things their doctors have actually said out loud to them. The resulting list would be truly hilarious if these comments hadn’t been so potentially deadly to the patients’ outcomes. More at: “Stupid Things Doctors Say To Heart Patients” on HEART SISTERS: http://myheartsisters.org/2011/01/13/stupid-things-doctors-say-heart-patients/

  • Barbara

    I am a medical librarian. I have several health issues that are complex. At this time and in this are, the DC metro area, I have to drive to get the care and understanding of the complications one procedure or treatment will affect my system. I am appalled at the cavalier attitude and at times, patronizing tone I hear. The best care I received was and is from teaching hospitals (Hutchinson, OHSU) when I leaved in the Pacific Northwest. I simply don’t understand the overall lack of communicaion in this area. Thank you for your post.