The failed primary care-hospitalist exchange: Who’s to blame?

Recently, I spent two days in Greenville, SC as a guest lecturer. During that trip, I had time to chat with some hospitalists. During our conversations, I explored a classic problem: the inpatient-outpatient handoff.

Talk with hospitalists and you will discover their angst about getting outpatient information on their admitted patients. Talk with primary care physicians and they echo the angst when seeing recently discharged patients.

Personally, I have experienced both sides of this conundrum. It would seem to the average person that this problem would have an easy answer.

Here is my list of challenges:

1. identifying the primary care physician (PCP)
2. contacting the PCP or their office
3. transmitting information (HIPAA rears its head as a perceived barrier)
4. finding out how the PCP wants to receive the information
5. discordant computer systems

A hospitalist shared with me the results of a meeting with a group of referring PCPs. Each one wanted the discharge information in a different way.

An integrated health system should make this easier, but too many patients exist outside any one system.

Can we emulate the VA and have a truly integrated medical record for all hospitals and outpatient settings? That rhetorical question could spur a day-long symposium. We have the privacy barrier, the hacking potential barrier and the profit barrier (for those who sell expensive EHRs).

So we redo tests and spend more health care dollars. We have patients get inadequate follow-up without the benefit of collegial information sharing. We get patients doctor shopping for more opiates. We get drug interactions because doctor B has no idea what doctor A prescribed. We have patients taking too much medication leading to additional side effects.

But we cannot blame the health care system, because we do not have a health care system.

And patients get caught in the midst of the chaos.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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