Tuesday, December 04, 2007

Primary Care Physicians - Quarterbacks of Your Health Care

I have learned never to assume anything in medicine. This is particularly true in coordinating my patients' care when more than one doctor is involved. Communication is essential for a successful outcome in medicine. This has become increasingly difficult in the health field for multiple reasons. Patients do not establish with a primary care doctor or they change doctors frequently, multiple facilities or specialists may be involved, and overburdened and overworked physicians lack the time needed to follow through on consultations as ideally as possible. The following case unfortunately demonstrates the poor outcomes which may occur as a result of a lack of communication.

A 37 year old man presented to the emergency room (ER) with a severe headache. He was examined by the ER physician (provider#1) who ordered a CT scan of the brain. The scan was reviewed by the radiologist (provider #2) who saw evidence of a blood clot but thought that it was an old injury. He did not contact the ER doctor with this information. The ER doctor then transferred the care of the patient to the new ER doctor (provider #3) at the end of his shift. He did not follow up with provider #2 regarding the results of the scan. The new ER doctor (provider #3) determined that the patient needed cardiac catheterization and transferred the patient to the cardiologist (provider #4). The cardiologist administered a blood thinner to the patient in preparation for a stent placement. The procedure was then performed by another cardiologist (provider #5). After the procedure the patient complained of a severe headache. At this point provider #5 reviewed the chart and found the radiology report which showed the old blood clot. The patient died of brain hemorrhage after the administration of the blood thinner.
Multiple failures of communication compromised this patient's safety.

To optimize your medical care, establish with a primary care doctor if you have not already done so. If you think that you have a good primary care doctor who is responsive and conscientious then stay with them when possible. A long-term relationship goes a long way to establish your doctor as your advocate. Keep your doctor informed if you seek medical care outside of his or her office. The medical system is a confusing one, and it becomes even more complex when you enter it during a crisis. Ideally a doctor who knows you will be in your corner and will help guide you through the maze by communicating and coordinating your needs with all who may be involved in your care.

reference: case from Norcal.


Dave said...

That is a scary story. I think that it is not all that uncommon, unfortunately.

These are complicated problems that are hard to solve.

Communication between human beings is poor at best and this type of problem doesn't just play out in the field of health care.

Unfortunately, we can't know everything and we human beings make mistakes - it is a fact of being human that will probably always exist.

If we could only see and know everything - things would be different, wouldn't they?

Thanks for this excellent post. I don't know what can be done, computerized records in hospitals could help. But if the information is never entered into the patient record - that really is a problem.


mohsen said...

خاتم رضوي انشاء الله موفق باشيد
به مدارج بالاتري هم دست پيدا كنيد
به اميد موفقيت شما

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Mahfot MH said...

Dr. Razavi,

I did asked my lecturer once about how to differentiate between ischeamic stroke and haemorrhagic stroke just from clinical presentation and patient's history. She just say one thing, "It's difficult."

She said, even MRI hardly can give useful information since the evidence of infarction (if it is ischeamic stroke) will only appear after several hours while we need to diagnose the patient immediately.

Maybe you can give your own opinion in this. Thank you.

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