Patients suffer from doctors' poor communication

Sick as you may be when you enter a hospital emergency department, your health may be in even greater peril when you leave after treatment.

A new study published by a health care think tank underscores how haphazard communication between ER doctors and primary care physicians can undermine effective care.

The research, done by the Center for Studying Health System Change, matched 21 pairs of emergency room and primary care doctors working out of the same hospital.

Among the conclusions:

— Patients' regular physicians seldom contact the emergency room on their own, even if they send a patient to the hospital.

— Emergency-room physicians rarely contact the primary-care docs either to clarify information or discuss treatment plans for a patient.

— But when the two doctors were able to connect on the phone, the result was often much more positive, and often less complicated for the patient.

— Doctors in the study said sharing medical records is cumbersome no matter what the mode. Faxed records were long and often hard to read; where electronic records were available, they often were either incomplete or not relevant to the particular problem.

Follow-up care by the primary doctor after a patient leaves the ER is also spotty. "Sometimes we try to piece together what happened based on the handouts a patient gets (in the emergency department) ... it's that primitive,"one family physician told the researchers.

But emergency doctors said many family docs have little idea that their nurses or associates are sending a particular patient to the ER, and may not even find out if they fax follow-up records and recommendations to them.

Dr. Emily Carrier, senior researcher for the study, said "there are no easy answers to the coordination issues between emergency and primary care physicians,"but said reform efforts should give doctors more financial incentive to coordinate care and continue efforts to improve health information technology. The report was sponsored by the National Institute for Health Care Reform.

Other research suggests doctor-patient communication in the hospital isn't much better.

A study by Yale University researchers published last summer in the Archives of Internal Medicine found numerous disconnects. Among the 43 doctors interviewed, 67 percent said their patients knew who was overseeing their care; among the 89 patients, just 18 percent could name their attending physician.

Seventy-seven percent of doctors said their patients knew their diagnosis; 57 percent of the patients said they were aware. And while 81 percent of the doctors said they had discussed possible adverse drug effects with patients, 90 percent of the patients said they were not told.

Other studies note that Medicare patients in particular have problems in being transferred from a hospital back to office-based care. Nearly 1 in 5 have to be readmitted within a month, often for the same condition. Medicare officials have been tracking the readmission rates and as of this year will start imposing payment penalties on hospitals that see too many "frequent flier"patients for the same medical problems.

But one of the larger issues that remain unresolved by health reform or market forces is a lack of enough doctors trained and willing to work in either ER or family care, and the continued time constraints faced by those who are in those fields.

While most of roughly 40,000 emergency department doctors nationwide have some level of specialized training, many smaller and rural hospital departments don't have such specialists and even more have trouble finding surgeons and other specialists willing to be on call for ER duty.

There are nearly 120 million emergency room visits each year, with most made by the very young and senior citizens, and the uninsured are no more likely than people with insurance to seek care in the ER. In fact, recent trends suggest that people with insurance and with a family doctor have led the growth in ER usage, in part because they find it so hard to get quick appointments or see their regular practitioner after-hours.

(Contact Lee Bowman at BowmanL@shns.com.)