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Thursday, March 01, 2007

Communication between Hospitalist and primary care physicians

It has been so long since I functioned as a officist and a hospitalist-a role known at the time as an internist- that I read with considerable interest an article in JAMA that concluded the current state of information transfer between hospital docs and PCPs was clearly in need of improvement.

Our pulmonary group enjoyed a large referral practice from a fairly wide geographical area of our state and it was thought to be very important to do three things when a patient was discharged from the hospital: 1) give the patient a summary of his/her medications and treatment plan, 2)call the referring physician and 3) write the referring physician and send him a copy of the discharge summary.

The JAMA article extracted data from numerous observational studies and present the reader with typical number of percentages too large to really keep up with. However, here are some:

Direct communication between the hospital physicians and the PCPs occurred only 3-20% of the time. Only 12-34 % of the time was the discharge summary available to the PCP at the time of the first discharge visit. In 2-40% of the time the discharge summary did not have information about the discharge medications.

While this article puts some worrisome numbers to one aspect of the current paradigm shift of the hospitalist phenomenon, there is more insight and enjoyable reading found in a brilliant 1999 NEJM article by Dr.Farrin A. Marian, to whom I believe we must give credit for the term "officist".He defines officist as a general internist who sees patients only in the office as long they remain relatively healthy.

The economic forces at work when I was a part time hospitalist gave us incentives to maintain close and mutually beneficial relationships with our referring physicians part of which was being sure they were kept well informed about what transpired with their patients. The economic forces now at work at least in some practice setttings may be a bit different.

I have been giving thought to the question "why do we have hospitalists anyway?" I am leaning to the conclusion that this is the result of physician fees price controls put into place in 1992 for Medicare patients and the controls placed on hospital charges for Medicare patients in efforts to control the rising cost of medical care for the elderly. Hopefully more on that later.


Aggravated DocSurg said...

I am afraid that I am not in the least bit surprised about the findings of this study. The traditional forces that encouraged effective communication between physicians have largely gone away. The officists don't really have any choice when they send patients to the hospital, and so the hospitalists don't sense a need to go out of their way to thank the officists for kindly referring them patients. It is a short slide from that position to simply abandoning all effective communication.

Anonymous said...

yeah...i think hospitalist that function within a group practice (hired by the group) are much more effective at communicating with the referring physician vs. the hospitalist that may manage patients for independent FPs in the community an hired by the hospital. Also at a practice i just left we've now created an electronic transmission of the discharge summary directly to the referring docs electronic medical record. of course you can only do this in an EMR enabled world which only occurs in less than 15% of practices today. -db