Thursday, July 31, 2008

Not enough information

I am a consultant. This means my job is to help other doctors with their patients. I am a little baffled by why other doctors perceive me as smarter than them in a least a very small way.

As a part-time chronic pain doctor, all my patients come to me by a referral.

Some chronic pain patients are very simple. I can take a history and examine them, come to a diagnosis and suggest or initiate treatment.

Most chronic pain patients are more complex. They have had a lot of procedures, medical trials and investigations. To properly assess this, I need to know what they have tried, for how long and in what dose. For example 100mg of gabapentin is a lot different than 3600 mg of gabapentin.

About a year ago, I saw a patient who had moved to town from another community. He had been getting injections with Botox from another doctor and wanted this continued as it seemed to have been working. He was however very vague about where or how much possibly due to a head injury or PTSD. Unfortunately the consult did not have much more than his name and healthcare number. A lot of times I can figure out what to do without my information. This patient wasn't one of those times.

Anyway I took the initiative to call the other doctor up and either discuss the patient or get the file.

This doctor as it turned out has the receptionist we all hate. She answered the phone, "Dr. X's office can you hold" and before I could reply, I was on hold. I put my phone on speaker and killed time for 10 minutes before I hung up and dialed again. The same thing happened. The third time I was ready and was able to interrupt her. I told her who I was, that I would like to talk to her doctor, that I knew she was busy and that I could give him a number to call at his convenience (GPs can actually bill the healthcare system for such phone calls). She just said, "well we're busy" and put me on hold again.

I therefore gave up trying to talk to this doctor or for that matter his receptionist. I dictated a letter and I asked for a copy of his records on this patient. I had told the patient that when I got the letter I would call him in for treatment.

Months passed. Every once in a while, usually while somebody else had me on hold, I would think about the case.

I came in this morning and found a handwritten note from the patient asking why several months later I had still not treated him. Apparently he had showed up the evening before in very bad humour and hassled the receptionist about why I hadn't seen him.

Any in a few weeks I will try to muddle my way thru a very unhappy patient.

Now in the 15 or so years that I have been seeing patients, this lack of documentation has been a major problem for me. When I worked at of CofE we actually designed a form where we asked for more information and would not book the patient until we had received the information. The thing is, most doctors offices have fax machines now; it is a simple matter to fax the rel event documents. It would take a secretary less than a minute. I know this because I frequently fax stuff myself (I thought it was neat when I learned to use a fax 10 years ago).

Almost worse than the family doctors are specialists who refuse to send you a copy of their consults when the family doctor either hasn't or can't send you a copy. Next to them are the family doctors who copy their entire chart so I have to sift thru the pap smear results to find the MRI report. Hospitals now seem to put their records on micro-film after about two years and actually ask you to come down and look for the records on the little micro-film viewer.

The monthly newsletter our friendly college puts out actually has a letters section. About a year ago, a family doctor actually wrote a letter to complain about the bad specialists who were demanding he send them information so that they could actually do a proper assessment on the patients he sent them. Now I would have thought that this would merit a public written tongue lashing from the registrar but it was in fact just published without comment.

(I should note that I did after I posted this (after I sent off an angry letter to the FP copied to the college) that I got an appologetic letter from the FP along with the info requested.)

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