As a family doctor I receive a lot of reports from emergency room visits, consultations and hospitalizations. Many such reports include a dozen or more blood tests, several x-rays and several prescriptions.
Ideally I would read all these reports in some detail and be more than casually familiar with what happens to my patients.
But how possible is it really to do a good job with that task?
How much time would I need to spend on this to do it well?
Is there any time at all set aside in the typical primary care provider’s schedule for this task?
I think the answers to these questions are obvious and discouraging, if not at least a little bit frightening.
10 years ago I wrote a post titled “If You Find It, You Own It” and that phrase constantly echoes in my mind. You would hope that an emergency room doctor who sees an incidental abnormal finding during a physical exam or in a lab or imaging report would either deal with it or reach out to someone else, like the primary care provider, to pass the baton – making sure the patient doesn’t get lost to followup.
But emergency room medicine is shift work, just like hospital medicine; providers may not be around when the abnormal result comes in, and the next shift worker perhaps can’t see what is in the first doctor’s inbox.
As I click through the “orders to sign off”, I end up prioritizing “my” orders, because I “own” them. The “Outside Provider” orders are in my inbox as a double check, but nobody double checks my results. I have to make them my priority if my time is limited and time, by definition, is always limited.
There is more and more data in medicine, and while I hope technology will make it easier to sort, view and prioritize data, I don’t believe artificial intelligence will do that well for frontline medical providers anytime soon.
I keep thinking that we really need to have a serious debate or examination of what we need primary care providers to do. The Patient Centered Medical Home movement (see my personal take on that here) held a promise of better care coordination by people like me in clinics like mine, but the way we do things hasn’t changed nearly as much as many of us had hoped.
I seriously believe that it would be a worthwhile investment for our whole healthcare “system” to structure and reimburse the care coordination work we primary care providers could do for our patients.
We can certainly use the help and collaboration of other professionals like nurses, but ultimately we need to know what’s going on with our patients. Otherwise their care will continue to suffer from more and more fragmentation as subspecialization brings more different doctors into many patients care “teams”, as hospital stays grow shorter with more loose ends at discharge, as options for urgent care walk-in and virtual visits increase and as more and more patients become afflicted with multiple chronic illnesses because of the declining health of people in this country.
When I started my residency in Lewiston, Maine back in 1981, family doctors were enthusiastic and idealistic. Much has dampened that enthusiasm since then, but I still believe we have a crucial role we could fill for the health of our nation.
If the “system” would only let us.
A Country Doctor Writes: 
Agree! Forcing hospitals to put an executive summary at the start of all discharge summaries would be a huge help….i.e diagnosis, what was done, what needs to be done…..should be no more than 3 sentences!
Just like I try to do with my own aSOAP notes: https://acountrydoctorwrites.blog/2019/01/14/the-perfect-office-note-soap-apso-or-asoap/
When my husband was first hospitalized back in June, I took it upon myself to accompany him to every consultation and speak with every doctor; read the results of every exam; follow up after he was discharged, and try to prevent his treatment from falling through the cracks. Referrals wouldn’t follow through, important specialists could not be reached in months, and important prescriptions coming out of the hospital direct to the pharmacy could not be back checked (the hospitalist did not communicate well with the pharmacy), resulting in incredible delays. I noticed that on follow-up visits his team care providers were rushing up to finish in the allotted time (15 min, half an hour, one hour etc), didn’t have easy access to a summary of the test results that warranted attention, were scrambling to get information out of the computer, and because of that they didn’t have time to look at the patient and examine him in detail. Members of his team didn’t communicate well with each other. Post-discharge follow-up home care was a joke, people popping up in our house announced for an X number of visits, they didn’t communicate with the primary doctor or specialists and vanished when their number of visits were up. We visited the ER six times in less than four months, sometimes the day after a consultation, because providers would have missed the relevance of important symptoms. My husband has since died, and I am left horrified with the way things did not work to his advantage. Although I believe that he might have died anyway, perhaps a little later if things had worked better with healthcare, I am scared as hell of the medical system as it stands right now, for those who stand a chance. Very sad.