In this situation, both PCPs and hospitalists could have improved Mrs. P’s care substantially, and reduced the cost of unnecessary care, simply by communicating. A call or text by the hospitalist to the PCP upon admission and at various decision points might have enabled Mrs. P to leave the hospital before any consults were called, before extraneous tests were ordered, before antibiotics were initiated and before she became more confused and weaker. More than half of elderly patients leave the hospital worse off than when they came in, and involvement of a PCP in a patient’s care could potentially facilitate more rapid discharge and less aggressive treatment.
Further reading: Is it time to open a walk-in clinic?
A recent survey indicated that 95% of hospital leaders are concerned that discharge communication is “inefficient” and 80% have concerns about communication among care team members. PCPs complain that they are never called. Hospitalists often state that they just don’t have time to call the PCP, but when they do, the PCP is not available. Each is culpable. Each must remember that the issue at hand is the patient’s care and welfare, not their convenience or preferences. It is a matter of professional responsibility. What could help? The electronic health record was supposed to solve these sorts of problems, but it has not and probably will not do so in the foreseeable future. There are some HIPPA-compliant texting systems that could be utilized and there are HIPPA-compliant smart phone apps that can coordinate among all involved physicians, nurses, hospitals, other facilities and even the patient. One of these types of systems could potentially negate the issue of non-availability, although it will not top the value of nuanced conversation among physicians.
In the end, there is nothing that trumps good physician-to-physician communication. It must be incumbent on hospitalists to involve PCPs during in-patient stays and it must be incumbent on PCPs to respond to hospitalists and provide crucial insight and information when asked to do so. Not only can outcomes be improved, but costs can drop and patients and their families can feel more comfortable knowing that their own doctor is involved in their care. If necessary, hospitals should set policy that makes hospitalist to PCP communication mandatory; everyone will benefit. Very basic solutions can frequently lead to profound improvement.
Andy Lazris, MD, CMD, is a primary care physician whose private practice focuses on geriatric patients, especially those residing in long-term care and assisted-living facilities. He is the author of Curing Medicare and co-author of Interpreting Health Risks and Benefits.
Stephen C Schimpff, MD, is a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, scientific adviser to Sanovas, senior adviser to Sage Growth Partners and is the author of Fixing the Primary Care Crisis: Reclaiming Relationship Medicine and Returning Healthcare Decisions To You And Your Doctor