Interaction between PC and specialists

[GoodmanBrown]

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I have a kinda vague question for FM docs. How do you typically interact with specialists (through patients, I mean)? Let me explain.

My wife's FM doc says one of the things he likes about FM is the ability to explain to his patients what the specialist didn't really adequately convey. (He's a low overhead, solo doc, so he typically spends 20-30 minutes per patient it seems.)

As an FM doc, do you usually know why the specialist is doing what he/she's doing? In other words, do you know what the tests are testing for and what the medications are doing? Do you do a quick uptodate refresher before speaking with a patient about what the specialist found?

Would you ever feel comfortable tinkering with the specialist's prescriptions?

Sorry if these questions are kinda vague. I'm just wondering how FM docs typically handle patients coming back from the specialist with a new diagnosis and new medications or treatments. Thanks!

 

[deleted87716]

Generally, I know what specialists will typically do in a given situation, and am comfortable explaining things to patients if there are any unanswered questions. If I run across something that doesn't make sense or that seems to be in error, I try to contact the specialist prior to changing/stopping any medications that they have prescribed. I consider this a common courtesy, and expect the same in return.

The biggest issue I face is getting notes from specialists in a timely fashion. Frequently, patients can't convey what a specialist said or did, and we have to try to get a copy of their notes (usually during the appointment, which is a PITA).

When in doubt, call the specialist. Communication is never the wrong answer.

Specialists who do a good job communicating with me (e.g., consistently sending me their notes) tend to get more referrals. Those who consistently disappoint me tend to end up getting zip. It should be a no-brainer.

 

[JackADeli]

...FM doc says one of the things he likes about FM is the ability to explain to his patients what the specialist didn't really adequately convey...

As an FM doc, ...do you know what the tests are testing for and what the medications are doing?...

...If I run across something that doesn't make sense or that seems to be in error, I try to contact the specialist ...I consider this a common courtesy, and expect the same in return.

...When in doubt, call the specialist. Communication is never the wrong answer...

As a specialist I must concur with BD. It is all about the communication. My view is that future business/referrals are secondary or gravy. My primary concern is best continued care for the patient. Achieving that requires everyone is involved and understands what is going on, what has occurred, what is planned, etc., etc...

When we see a referral in clinic, we dictate a letter to the referring physician AND PCP if they are not the referring physician. We also routinely ask the patient if they have any other physicians involved in their care that they feel should be informed. It is real easy to dictate one letter and have it "cc" to a laundry list of providers via the dictation. In our system, that list at the end of the letter creates an automatic transmittal to each named physician in addition to the referring physician the letter is addressed to. When our patient leaves the hospital, we again dictate a letter to the patients' physician/s. This is in addition to the standard discharge summary.

We have found that our practice of direct inclusion in dictation as well as being available by email, cell, etc reciprocates. Thus, I have not had issues with PCPs trying to explain our care or plan so much, rather, they feel comfortable to contact us directly should the patient or family be confused or have additional unanswered questions.