Wondering why doctors don't communicate with one another readily

[agate]

Each doctor is in business for his/herself, right? And so maybe some doctors just don't see much point in communicating their findings about a patient to other doctors even if the patient requests it?

There's been much talk about "coordinated care." I always thought that part of that idea would involve doctors sharing their findings about a patient with that patient's other doctors as necessary.

But repeatedly I've found that one doctor doesn't bother to do the "coordinated care" routine unless the patient really insists.

I've seen the podiatrist 4 times since June about the foot fracture. Xrays were taken, chart notes were made. After that first visit I specifically asked the doctor's office to make sure that my primary care doctor received the results. I was assured that that would "of course" be done.

Today--more than 4 months since that assurance--I learned from the primary care doctor that she never received anything. I got right on the phone when I got home and prodded the podiatrist's office to send the records. They're hemming and hawing about sending the Xrays but they'll send the chart notes. They'll see if they can send the Xrays.

Moreover, the primary care doctor told me I really should have gone to the ER after that fall, and told me I could call their after-hours number and she would have seen me the next day. She was concerned about the foot injury and I'm glad she has an interest in reviewing that.

I keep learning that doctors and their offices can't be assumed to be getting things right. We have to keep an eye on them. It's in our interest. They make mistakes. They're overloaded.

[Lazarus11]

Good post Agate. Very frustrating.

[agate]

Time and time again, over the years, I've assumed that of course since a number of doctors had me in common as their patient, it was in my interest for them to let one another know if anything significant was going on so far as their findings were concerned.

But they don't always keep the patient's best interests in mind. Maybe they assume that we patients will keep them posted about any developments while seeing other doctors.

That's where there's quite a serious disconnect. The patient is assuming one thing, the doctors are assuming another.

I guess we need to keep it firmly in mind that if a specialist has diagnosed us with a condition, our primary care doctor probably won't know about it unless we tell him/her.

[flatcap]

It limits my choices to some degree, but I try to keep all of my healthcare within one medical system. Nearly all of my records are in one central location. Everyone in the system, including my PCP, has instant access to them. Presumably, although not surely, providers in the system communicate with each other as needed.

However, two of my providers are independent, so my records are 'incomplete' in that regard: those from my neuro and those from the behavioral health specialist I see. I think my neuro has transmitted my records to my PCP, but I never checked, so I don't really know. To be honest, I'm not sure I could care less. I am virtually certain my behavioral health specialist hasn't transmitted my records yet. She opened her own private practice in January, and the office is still coming up to speed.

I don't know how much good my records from whatever source do anyway. My PCP appointments are limited by the usual 20-minute time period you get for them. That is hardly enough time to address day-to-day issues. My PCP is pretty thorough, though. You should see his chart notes. They're longer than my average post — LOL.

I guess I'm not too worried about the records issue or whether my providers communicate with each other. I assume they don't and try to plug the leaks myself. I bring notes with me to my appointments so I don't forget to bring up the important things, including what I know about test results. If I can, I get a USB drive with images and bring those, too. If one of my independent providers prescribes something new, or if my condition changes in some other regard, I report it to my PCP. If something changes in my primary care, I report it to the independents. I am not aware of any problems along this line but will ask all of my providers about this subject at my next appointments.

Thanks for bringing this up, agate. I'm kind of lax at it, but you're right: we need to be our own advocates and must try to stay on top of every little thing, including our records and who has them. Increasingly, self-service seems to be the order of the day in all things. It saves money, but it does not make for better healthcare. We have to make up for it as best we can.

[agate]

flatcap, the days of your caring doctor who may have known you for decades seem to be long gone but those of us who knew such doctors (all too many years ago) might be lulled into thinking that today's doctors are giving us the same consideration and attention.

It looks to me as if the typical doctor or specialist or medical provider of any kind has so many patients that it's impossible to think very long about each case. We cases have to do far more thinking about it, on our own behalf, than we may have realized.

[flatcap]

I agree and think an overload of cases is pretty much standard now for providers. Insurance policies drive the push towards lower costs, and providers are forced to respond by increasing their case loads. Providers suffer as a result of having too much to do, as do their patients.

As you said, the good old days of providers having reasonable case loads so they could give patients adequate, individualized attention are gone. It seems the only exceptions are providers in independent practices. Some aren't in the game only for money, although I am sure some are or make it their highest priority, just like large, for-profit healthcare systems do.

My behavioral health specialist quit the system she was in and started her own practice for this very reason. They were pressuring her all the time to increase her caseload, and she was sick of it. She is in her 60s, so I'm guessing she also misses those good old days. Now, she can take however much time she needs with a patient, and she does.

[agate]

Yes, and one clue that this is true can be found if you happen to learn that every time you set up an appointment, you can also find out just how long that appointment is scheduled to last--and notice that, no matter what, the medical provider tries hard to stick to that scheduled length of time.

I've been told by office staff people that my appointment is scheduled to last 20 minutes, or 30, or whatever. I don't ever ask. The information just comes my way because they tell me. Maybe it's their way of suggesting to me that I'd jolly well better not stick around any longer than that.

My dentist's office shuts down for an hour for lunch at noon. I've been told when scheduling an appointment at 11 that I can be sure to be out of there by 12. I often wonder how they can be so sure of that. What if the dentist is pulling a tooth and discovers a bit of bony growth that needs to be removed as well--and therefore the procedure will take longer than scheduled? (I've had this happen.)

[flatcap]

Let's hope your dentist can work within his/her self-limiting lunchtime schedule. If s/he cannot do this, then once again, if it were me, I would find a new dentist, one willing to work 'overtime' to get things right if needed. Even my somewhat sketchy former dentist was always up for that.

[agate]

I'd agree with that new-dentist idea except that I've run into this lunch-shutdown situation at any number of medical facilities. The lunch shutdown time makes it difficult when someone like me, someone not adept with a cellphone, has to wait for transportation on the premises but there is nobody at the desk to make a call if needed.

One dentist's office, years ago, literally shut the whole building down, and I had to wait outside in the cold rain for quite a while for the van. There was an overhang where I could wait, and so I wasn't being pelted with rain but still I did realize that things were easier back in the day when I used ordinary buses, which usually ran on schedule, and so I didn't have to wait very long--10 minutes maximum usually--until a bus came along. I wondered why someone disabled enough to need a wheelchair should have to wait for transportation longer and less conveniently now, when there is supposedly more protection in place for the disabled....

If I were running a medical facility, I'd make sure the staff alternated lunch times so that at least one person would always be there during the lunch hour, and the place would stay open. If I had Bob, Sharon, Mary, Matilda, Nancy on my staff, I'd ask Bob to take the 12 to 1 lunch time in the office and take his lunch from 11 to 12 or from 1 to 2 on Mondays, and ask Sharon to do do the same on Tuesdays, etc. Seems simple to me, and it would even benefit the practice because important calls wouldn't be missed during that time. Paying customers might be calling in during that time.

[flatcap]

Sorry, agate, but your proposed solution is unworkable in a medical setting. It makes too much sense.

As for the disabled having more protection nowadays, my experience showed me the ADA is a hollow rag. It sounds good, but in real life, it really isn't there for employees, so it does not surprise me it didn't protect you. They can get away with it, and they do.

[Virginia]

I don't see a neurologist in the same group as my PCP. However I have a feeling the NP that I see at the neurologist office now provides the PCP with my records. This came about when the PCP took me off some medication I had been on for 40 years. I was afraid it would have an affect on my MS. She became argumentative about it, but then at a later appointment readily prescribed that same medication and said she had my records.

This doesn't bother me at this time. I am still able to tell my Doctors anything they need to know. However, it was many years ago that it bothered me. When my husband had cancer and there were a number of Doctors involved. It was all I could do to try and take care of him. He had a hole left in the lining of his stomach after surgery and it continued to drain. I was taking care of that in addition to caring for someone who had just had 60 percent of his stomach removed. I remember constantly thinking the PCP knew what was going on with the surgeons, the oncologist, the infectious disease doctor and all the myriad of doctors who were in on this. It became confusing and at times more time consuming than I could afford without taking time away from him. We had been with the PCP a long time and I resented him not taking the time to find out what was going on with my husband.

Now there are computers and even if doctors are not in the same large groups, it is usually easy for them to share records with another group.

[flatcap]

I am sorry to hear of your experience, Virginia, but it is crystal clear your husband was fortunate to have you in his life. Many people have no support resembling what you did for him. And many of us without any kind of support in such things fear the day when the stakes rise to the level of our survival. I know I do: I will be on my own.

[Virginia]

Flatcap, I am glad I was healthy enough to do the things I did back then. I was 49 when my husband passed away. I am afraid that like you I would not have anyone either. I have two brothers but one is not able to do anything and the other one is involved in his children's and grand children's lives. He also lives quite a distance from me which would further complicate the situation.

[agate]

We had been with the PCP a long time and I resented him not taking the time to find out what was going on with my husband.

Yes, it's that kind of situation that troubles me, Virginia. Primary care doctors are supposed to have a clue about what is going on in connection with a patient's health--every aspect of it, or at least that's what I would expect of a "primary care" doctor. But it seems as if one doctor doesn't want to poach on another doctor's "territory" even to the extent of reading a patient's medical records from another doctor.

[Mike Weins]

After receiving the run-around and having to repeat not only my symptoms/complaints but tests (x-rays in particular seem to be sacred and un-sharable) numerous times, I don't leave any doctor or dentist office without a full copy of any records that the office has on me. In the last three years I have accumulated two three inch three ring binders full of my records from over a dozen different providers, and there's still more to come.

The days of doctors talking to anyone outside of their office/hospital are long gone. Too many have too many patients to see and keep track of. Shoot even the doctors within the VA hospital I go to don't always talk to each other and it was a pain getting records from one department to another. Even the VA health portal doesn't have all of my records.

You and you alone are the only one that has an inkling of what's going on with your own health. Sadly it's up to you to take the steps needed to ensure that every doctor/specialist/care-giver has all of the information that they need.