Improving communication within medicine
Every GP I know has the same frustration. The call to the hospital switchboard. “I’m after some information about my patient’s recent admission…” or discharge, emergency department attendance or when they will be seen in outpatients. Followed by the almost invariable irritation of being put on hold or being diverted to a few departments or people before you get to the right person.
At this point you might get “lucky” and be provided with the information you should have received long before and need to provide the care your patient needs. Or you may have to cross the next hurdle – usually done by gentle cajoling as you explain that it really is OK to provide you with the information “because I am the patient’s GP”, or “but I referred the patient in… even though it may not be on your system”. Sometimes it still doesn’t work, so you grind your teeth as you organise to send a letter (sometimes only the hospital prescribed form will do the trick) with your patient’s written permission to get the information.
Meanwhile your patient is incredulous. “But they said they would let you know,” or “don’t you all work together?”, or “but they told me to come to you for follow-up”. At the very best, it’s a waste of time and effort by all. At the worst it’s dangerous. And somewhere in between is a loss of patient confidence in the system and the overwhelming feeling that there is no healthcare system, just independent pieces and that there is little understanding or respect for your role in it.
Likewise hospitals have their own frustrations – the referral letter for outpatients that asks “please undertake the needful”. Add to this little detail on what the problem is, the relevant examination and investigation findings, the management to date and what the objective is of a referral to the hospital. Or the referral letter for pregnancy care that has the “pill” and roacutane listed as medication – really, or does this require urgent follow-up? Or the elderly patient who has to wait hours at their outpatient appointment because the referring GP didn’t let the hospital know an interpreter was required.
Each one of us on the AMA Victoria GP section has had too many of these experiences over too many years. As a GP who works in both community general practice and in a hospital, I have seen both sides of the coin. As such we have recently developed and had endorsed by the AMA Victoria Board 10 Minimum Standards for Communication between Health Services and General Practitioners and other Treating Doctors. It outlines minimum standards for a range of issues, including the quality of a referral from a GP to a health service, the capture of a patient’s GP details by a health service, timely and appropriate provision of information about care and appointments and discharge care planning.
To guide health services as they develop their eHealth systems it also includes a standard for expectations for electronic information transmission to and from GPs. The AMA is in the process of promoting the standards to relevant stakeholders. Take a look here and let me know what you think by emailing firstname.lastname@example.org. If you like it, please refer to it and spread it around.
Dr Ines Rio
Chair, Section of GP
This article appears in the June/July 2017 Vicdoc.