In an ideal world the specialist receives a full written letter from the referring clinician with the relevant medical history. If you’re lucky, a quick list of meds and allergies and a brief review of their medical history. In reality it’s often a phone call, maybe a written note. In return the referring clinician deserves a full written explanation of you’re opinion and treatment plan. In reality, they often get nothing or get some sort of brief letter days, weeks or months later. Specialist/Generalist communication is a frequent soft spot for litigation so improving it can only help with patient care and defensive medicine. Here are my suggestions:
It’s a trade off: If every patient had a dictated/typed note to the generalist at every visit I would run out of hours in the day. I would either increase my wait times to make room or make the letters so short their pointless. Good practice management will find the right balance.
Cross Train: We use an in-house transcriptionist. The extra amount we spend on in-house staff vastly improves communication because she’s a specialist in our practice. She’s cross-trained to read our operative notes, the schedule and billing information. At the end of each day, she looks for letters that should have been sent and emails the clinicians.
Informative vs Opinionative: Think of your letters as either informative or opinionative then automate the hell out of the informative. Luckily for our practice, most of our work is routine procedural stuff (wisdom teeth, dental implants, benign biopsies, etc…). The generalist refers’ the patient to us, knowing what the likely outcome will be. The letters sent back are just informative ("as referred we extracted the wisdom teeth", "completed the biopsy and it was benign", etc..) so use templates and the transcriptionist fills in the details from the operative notes. A note is added to the bottom to let the generalist know that it’s done this way. Opinionative letters we dictate, proof and digitally sign.
A Mic in Every Room: We use EMR technology and I’ve put a microphone on all of the desktops. I have now gotten into the habit of dictating while the patient is sitting in front of me. That way they know what I’m saying (and occasionally correct it) and they know that the letter is going out quickly.
Digital Communication: We try to get as many referring clinicians as possible to go to digital technolgoy. It lowers wait times, although it’s really only the difference of a day or so in the mail. The real benefit is to simplify the process for us. I dictate into the computer. The transcription system technology is built into the EMR to track dictated letters. If we email it out, the entire process never leaves our EMR system and the chance of error is low with little wasted work.
Templates and Voice Recognition: I love templates. I have them for all sorts of consults and procedures and they make it simple to create good letters for stock consultations. I’ve tried the voice recognition and I cannot get it to work as fast I want (accurately). So, for now, I don’t use it.
Complex Case Coordinator: About once a week we have a case that will become complex with multiple stages to surgery and/or multiple other clinicians. In a case like that a major case coordinator is involved (we currently have one for 8 doctors). She ensures that the patient is not left in limbo somewhere. It’s still not perfect, but I’ve found that patients’ perceive our office is the one with the greatest amount of coordination and organization.
Outside Lab & Biopsy: Any copies of outside communications are immediately emailed/faxed to the referring GP. Because we deal mostly with dental generalists they are rarely on the lab’s list of people to carbon copy so our office does it.
And there is what we’ve done to stream line communication with generalists. Good people, using technology to improve process flow and keep the error rates as low as possible. On a quick note about accuracy, GP’s do not care where the system breaks down, just that it does. As I’ve post before (see the six sigma posts) complexity creates problems so I try to streamline processes as much as possible. A 15 step process will fail much more than a 3 step process. This has been one of the problems with email – it’s more likely to have a dropped email (due to addresses, spam, virus, etc…) than a lost mailed letter. Hope that’s an adequate Mea Culpa Dr. Rob! Ian.