Best ways to communicate with specialists

March 21, 2008

This doctor learned that reading others' chart notes is not enough.

Recently I met, for the first time, an ophthalmologist who has cared for many of my patients over the past 13 years. Although I've received numerous consult notes from him, we had never spoken before.

By contrast, a surgical colleague calls me after each visit from one of my patients. Sometimes I feel a bit annoyed to be pulled out of an exam room to listen to the surgeon's updates on seemingly stable patients. Yet I appreciate his effort to keep me informed about my patients' care.

In describing these contrasting forms of doctor-to-doctor communication, I use the terms "parallel" and "interactive" medicine. The first occurs when doctors who follow the same patient communicate indirectly, through consult notes or notations in a hospital chart. Medical care is provided in parallel by each of the physicians, who have no contact other than reading each other's notes. Frequently, the documentation is illegible or incomplete, and doesn't fully convey the physician's thought process.

Consider the case of a patient of mine who was losing weight for more than a year, while numerous diagnostic studies, including a CT scan of the abdomen, failed to reveal the cause. Finally, I felt a rock-hard, mid-abdominal mass while examining the man, who by then weighed only 80 pounds. I went out of my way to meet with the radiologist to review a follow-up abdominal scan.

At first, the radiologist read the scan as negative. But when I insisted that there was a peri-umbilical mass, we both looked again-and detected the image of a calcified mass, a sarcoma, hidden within the contrast-filled loops of small bowel. By working together, he and I were able to pinpoint the cause of the patient's continual weight loss. If all the specialists who'd seen this patient over the past year had conferred with one another, I believe, the diagnosis would have been reached far earlier.

Of course, physicians are too busy to personally contact each other every time they see a patient. But in certain cases-such as critically ill ICU patients; those undergoing major surgery; patients with life-threatening or markedly abnormal diagnoses or test results, and those who fail to respond to therapy-direct physician-to-physician dialogue should be the norm, rather than the exception.

In my community, physician communication seems to be good, but I'd like it to be better. If I received more phone calls from local ophthalmologists when my patients with hypertension or diabetes presented with visual problems, I could become more aggressive earlier on about controlling their blood pressure or glucose levels.

Find a way to touch base

To promote interactive medicine, we can share our cell phone numbers and back lines with our colleagues and instruct our office staff to pull us out of exam rooms to take critical phone calls from other physicians. And, because we're too busy to play phone tag, we should also consider the use of secure electronic messages that could reach us whether we're in the hospital or the office. Of course, we'd have to check our e-mail regularly, but that isn't any more difficult than checking voicemail.

Like other physicians, I often do "hallway consults" at the hospital with specialists who are caring for my patients. Today I bumped into a pulmonologist and gave him a heads-up about the condition of an asthmatic patient I'd referred to him so he'll be prepared for her visit later this week. But discussions about our patients shouldn't be limited to hit-or-miss meetings in the hallway or the doctors' lounge. Making time for communication may be hard. But it's essential to the delivery of top-notch patient care.