Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean.

Specialist’s recommendation (ortho, seen for fracture):

Frequent falls resulting in head trauma as well as the current injury should be addressed. Recommend workup for balance/equilibrium disturbances.

Do you think the fifth of gin the patient admits to consuming daily may have something to do with that? I called your office and let them know of my concerns. Thanks for the recommendation though.

Cardiology recommendation:

Patient appears to have signs of early dementia.

Actually, he told me his hearing aid was broken on the day of his appointment with you. He’s sharp as a tack when he has it in.

Gastroenterology note:

Patient was non-compliant with colonoscopy prep, medication and dietary instructions.

I told your office manager that this patient has “limited literacy skills.” He can’t read. I’ll bet you handed him a stack of papers containing the bowel prep, directions for the three new meds you gave him, plus detailed dietary information, said, “Any questions?” and left the room before he could say, “Um …?” How compliant would you be if I threw you all that information in, say, hieroglyphics?

I know how hard it is for specialists to admit I may know more than they do about my patients. That may be why my attempts to provide extra information fall so often on deaf ears. But if they listen to me, they may find it easier to make meaningful recommendations.

Now watch me get inundated with comments about dreadful primaries who never call to share the most basic information about the patients they refer, leaving the heroic specialist to save the day. There are bad apples everywhere, and everyone believes their experience is “reality.” These are actual [well, modified for anonymity] letters I’ve gotten from specialists making nonsensical recommendations based on incomplete information. It cuts both ways.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.