Communication Gap Among Doctors

Do you see specialists? Do you use urgent care clinics? Have you been hospitalized? In all of these scenarios, doctors other than your primary care doctor provide your care. Do you know that your primary care doctor does not always receive information from these other providers? Clearly, it’s beneficial for your primary care doctor know how and where you’ve received care since your primary care doctors should coordinate all of your care. But, as important as this is, it is sadly not happening for many patients. And this communication gap among doctors is endangering our health.

Why is communication between doctors important?

Clearly, it’s impossible for your doctors to provide appropriate care if they don’t have access to all of your medical information. If your doctors don’t know your test and lab results, diagnoses, treatments and medications, they could make potentially harmful decisions.

For instance, adding a new medication without an accurate list of other medications can lead to dangerous medication overload or adverse drug interaction. Or a doctor without access to a patient’s complete history could mistakenly think side effects from a medication or treatment could be a new medical condition.

The list of potential problems is endless.

Doctors struggle to communicate and coordinate care.

Results of a 2019 survey by the Commonwealth Fund show a communication gap among doctors that makes it hard to coordinate care. The survey, with responses from over 13,000 primary care doctors in the US and 10 other high-income countries, showed that the use of electronic health records has not solved this potentially dangerous problem.

The survey asked the doctors how often they electronically exchange patient information, such as clinical summaries, lab and diagnostic test results and medication lists, with doctors outside of their practice. The results show that doctors in the US and in several other countries do not routinely exchange information electronically outside their own practice.

Furthermore, a substantial number of primary care doctors in the US reported they “did not routinely receive timely notification or the information needed for managing ongoing care from specialists, after-hours care centers, emergency departments or hospitals.”

Although doctors from every country reported struggling to communicate with other doctors, those in the US seemingly struggle more than the doctors in the other 10 countries.

Here are some findings from the survey:

• 49% of US primary care doctors said they communicated with specialists seen by their patients, compared to at least 70% of doctors in France, New Zealand, Norway and the UK.
• 40% of US primary care doctors, 38% of Australian doctors and 42% of Canadian doctors routinely coordinate with patients’ social service and community providers. In contrast, 74% of German doctors and 65% of UK doctors regularly coordinate care in this manner.
• Slightly more than 50% of US primary care doctors report they can exchange patient clinical summaries, lab and diagnostic test results, and patient medication lists with doctors outside their practice. In contrast, the vast majority of doctors (72% – 93%) in the Netherlands, New Zealand, Norway and Sweden reported having these abilities.
• 52% of US primary care doctors reported they usually receive a report from a hospital within 48 hours of discharge. In comparison, only 1/3 or less of doctors in 7 other countries report getting these discharge reports within this timeframe.

Another survey demonstrates the struggles of sharing medical information. 

A 2015 survey of US doctors found that only 64% of doctors who use EHRs received summaries after their patients were discharged from a hospital. Additionally, only 49% of doctors who use EHRs reported they can share medical information with doctors from other practices.

Another study found ER and primary care doctors often don’t communicate.

A 2011 study found that communication between primary care doctors and ER doctors is haphazard and care coordination is lacking. Furthermore, even when ER doctors and primary care doctors all worked for the same hospital, they rarely shared patient information.

Both sets of doctors agreed that better communication would help patients have more positive outcomes since these doctors could discuss diagnoses, treatments and recommendations for follow-up care.

Many patients notice the communication gap.

A 2016 survey found that only 1/2 of patients said their healthcare providers share information about their care and are aware of their medical history before an appointment.

Why haven’t EHRs improved the communication gap among doctors?

It seems logical that Electronic Health Records (EHRs) would help doctors share patient information, but that is often not the case. However, there are thousands of EHRs used in the US, most of which can’t communicate with each other.

Instead of a system of interconnected data, EHRs today “largely remain a sprawling, disconnected patchwork“. The hundreds of EHR vendors often do not design systems that can communicate with each other.

Furthermore, customizable EHR designs can prevent communication between EHRs used by different doctors in the same hospital system. Instead of relying on electronic communication, doctors still use old fashioned fax machines and CD-ROMS to share medical information.

For more information on EHRs, read my blog post: 6 Dangers of Electronic Health Records.

What can you do to overcome the communication gap among doctors?

Importantly, realize you must be the “captain of your ship”. Do not assume each doctor has seen notes and test results from your other medical providers. Instead, be prepared to accurately relate your medical information to every provider you see.

For example, know your test and lab results, diagnoses, treatments and medications. And, make sure your primary care doctor is kept in the loop!

To make this easier, consider the following:

• Be sure you understand what your doctor is telling you. If you don’t understand what the doctor says, ask the doctor to rephrase or repeat his/her response
• Use a notebook to take detailed notes at all doctor’s appointments. Bring this notebook to every medical appointment.
• Ask each doctor for a printout of his/her notes at the end of each appointment. Read them over to check for accuracy and let the doctor know if you see mistakes. And, bring these notes to every medical appointment.
• Keep accurate, up to date records of all test results. Keep them organized in a folder and/or notebook and bring this information with you to every appointment.
• If you feel that you would benefit from your doctors speaking to each other, ask them to call each other.
• If you go to the ER, call or email your doctor to share the details of your symptoms, diagnosis, treatment and recommendations for follow-up care.

Learn more…

For more tips for getting better care, read these blog posts:

• Understanding Medical Information Is Harder Than Most Realize.
• 10 Tips for a Better Medical Appointment.
• Why Take Detailed Notes at Doctor Appointments?
• Should You Record Medical Appointments?
• How Can You Get the Best Healthcare? Actively Participate!
• 10 Tips to Communicate Better with Doctors.
• 6 Tips to Better Manage Your Care.