Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

ACP: Making transitions better for patients

Fred Ralston Jr., MD
Physician
January 5, 2012
298 Shares
Share
Tweet
Share

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Many patients see multiple doctors and receive care in a variety of settings. Some patients receive care in more than one hospital. As an internist who is in the process of transforming into a patient-centered medical home, I have been taking steps to help my patients when they see other physicians.

All physicians can recount instances when they saw a patient with too little information. That works both ways. I know my patients have been seen elsewhere when additional information from me could have helped their care.

Scheduled referrals give a wonderful opportunity to share information. Hopefully, those of us making the referrals will not simply dump data from old records but will at a minimum list the pertinent issues at hand and the questions being asked in the referral. Physicians receiving referrals can then respond with their impression in a readable format and update that report if the impression changes with additional information.

When patients are seen in a hospital it often is not scheduled and poses more challenges in both directions. As an outpatient physician, I greatly appreciate notification when my patients are admitted to a hospital so that I can provide whatever information is needed, and a prompt discharge summary is always helpful to me in the first post-hospital visit.

When information flow works smoothly, it is easier for all involved in care and the patient benefits. What are the barriers to effective information flow? What are the opportunities to improve this flow? I’ll share some thoughts and would appreciate the perspective of those with other vantage points, particularly hospitalists and doctors seeing patients on referral.

As a general internist in a small town my patients are either hospitalized in our local community hospital or referred to one of two main tertiary centers. While I practice only in the office, I make “social rounds” in our local hospital and perform the handoff personally, copying records and passing along particular perspectives based on what is often many years of getting to know the patient well. I can also validate in the patient’s mind the care he or she is receiving in the hospital.

I appreciate progress reports from the hospitalist and prompt discharge summaries so that I will know where my attention needs to be directed in that first visit.

Where there is not in-person contact, the communication can vary tremendously depending on the efforts of those involved. It is helpful to get a notification when a patient is admitted to an out-of-town hospital with information on how to contact the physicians caring for the patient. I must confess that I often see the responsibility one way; after receiving that information, most physicians – myself included – could do a better job of sending relevant information to those caring for my patient.

It would be helpful to make a new expectation that part of the discharge planning process be to notify the primary care physician of discharge and make sure that proper records including a discharge summary be available before the first post-hospital visit. Most hospitals seem to have requirements for timely summaries but in many cases they are either not done or not transmitted by the time of the first outpatient visit. This would seem to be an excellent opportunity to improve patient care.

Most of us have seen data suggesting that a significant portion of patients readmitted within 30 days have not seen a physician in the outpatient setting. That should not be noted as simply another “ding” in the report cards that seem to be coming from all directions but a failure of the system to provide continuity of care.

We all try to do our best when we see a patient. The goal of excellent patient care is not met when avoidable complications occur due to a suboptimal handoff. What are your thoughts on how we can make transitions better for our patients?

Fred Ralston practices internal medicine in Fayetteville, Tennessee, and is the Immediate Past President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

The lack of underrepresented minorities in STEM

January 4, 2012 Kevin 4
…
Next

Risks and benefits of direct access to lab results

January 5, 2012 Kevin 5
…

Tagged as: Hospital-Based Medicine, Hospitalist

Post navigation

< Previous Post
The lack of underrepresented minorities in STEM
Next Post >
Risks and benefits of direct access to lab results

More by Fred Ralston Jr., MD

  • a desk with keyboard and ipad with the kevinmd logo

    ACP: A Senate intern turned internist seeks solutions to better patient care

    Fred Ralston Jr., MD
  • a desk with keyboard and ipad with the kevinmd logo

    ACP: Reducing expenses at the ground level of health care

    Fred Ralston Jr., MD
  • a desk with keyboard and ipad with the kevinmd logo

    ACP: If I were health care king

    Fred Ralston Jr., MD

More in Physician

  • The shifting landscape of gastroenterology manpower and compensation

    Brian Hudes, MD
  • Surgical procedures for inpatients: Addressing socioeconomic urgencies

    Deepak Gupta, MD
  • I’m a doctor, and I almost died during childbirth

    Bayo Curry-Winchell, MD
  • A message of hope for physicians

    Kim Downey, PT
  • From aversion to office politics to embracing independence

    Osmund Agbo, MD
  • Navigating medical decision-making: Embracing limits and growth

    Benjamin Wade Frush, MD
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Reduced Mortality Seen in Cancer Survivors Who Meet Exercise Guidelines
  • CDC Advisors Endorse Maternal RSV Vax to Protect Newborns
  • Amoxicillin Alone for Acute Sinusitis Holds Up Against Broad-Spectrum Cousin
  • Despite Taboo, Med Students, Doctors Use Substances Too
  • White House Opens Gun Violence Prevention Office

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

ACP: Making transitions better for patients
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...