The following op-ed was published on May 4th, 2008 in the Nashua Telegraph.
Communication in medicine grows worse by the day. What should be a pillar of quality health care is instead a resounding failure.
Patients are rushed through office visits and often leave without having their questions answered. Labyrinthine barriers have to be overcome before speaking with a physician. Reaching a medical provider via the Internet is an impossibly daunting task. Doctors rarely talk to each other to coordinate treatment plans.
With appointments packing schedules in 15-minute increments, physicians report there is not enough time to conduct an appropriate office visit. This is to the patient’s detriment, as studies show that the public adequately understands their doctor’s instructions only half of the time. In today’s digital age, one should ideally be able to e-mail or instant message their providers to ask follow-up questions.
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This infrequently happens, as Medicare and private insurers rarely pay for electronic communication. A physician who repeatedly handles patient requests outside of an office visit will lose money, contributing to the reluctance of the medical community to embrace the Internet.
This is unfortunate, as judiciously utilizing “virtual” Internet-based visits and secure e-mail can both increase patient satisfaction and reduce health care costs.
Communication between medical providers, or coordination of care, is similarly uncompensated and devalued. It shows.
The New England Journal of Medicine reported that specialists and primary care physicians are not satisfied with the information they send to each other. Emergency departments sometimes treat patients without accompanying medical information. The time it takes a primary care physician to receive a specialist’s report can exceed a month.
It seems counterproductive that physicians have such a hard time talking to each other when the system is becoming increasingly fragmented. Consider that the average Medicare patient sees seven different doctors annually. Combined with the advent of “hospitalists,” or doctors who only practice inpatient medicine, the days where a single physician who cared for a patient from the office to the hospital and back are fading.
Nashua is fortunate that both St. Joseph Hospital and Southern New Hampshire Medical Center have established hospitalist programs that communicate well with primary care physicians. This, however, goes against the national trend that finds clear and comprehensive information exchange between hospitals and outpatient medical offices to be lacking.
Universal electronic health records are an optimal solution to address these issues and have been shown to decrease the incidence of medical errors arising from miscommunication. However, the short-term costs of adopting electronic records are steep.
Physicians pay for startup costs that can exceed $20,000 per doctor and find much of the return on investment goes to the insurance companies or the government. This is a major reason why only a quarter of physicians’ offices nationwide have implemented such systems.
How can we improve this glaring failure to communicate?
We must change the incentives within the health-care system. Instead of the current reimbursement system encouraging doctors to maximize the number of office visits and procedures performed, pay them for spending time with patients and coordinating care with other medical providers.
It is also imperative that electronic records be adopted, thereby reducing medical errors and facilitating the transfer of health information. The government and medical insurers need to provide the financial resources for doctors to make this critical leap forward.
As for patients, be aware of the difficulties physicians face when trying to talk to one another. Know your medications and medical history when seeing a new specialist or receiving care in the emergency room. Ensure that any new treatment recommendations are appropriately communicated with your primary care physician.
Our health care system has plenty of room for improvement. Simply making it easier for medical providers to talk to both patients and each other would represent a significant step in the right direction.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
