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Communication Problems Between Primary and ER Docs Contribute to Medical Errors

In today's modern health care system, primary care referrals, insurance restrictions, and crowded waiting rooms are common. While doctor-patient relationships and communication have been the subject of study, doctor-doctor communications have been less so. This past March, the National Institute for Health Care Reform (NIHCR) found that doctor-doctor communications are also key to reducing serious doctor errors and improving outcomes.

The NIHCR, a non-profit, non-partisan organization that conducts health policy research and analysis, conducted 42 telephone interviews in 2010 with 21 pairs of emergency department and primary care physicians. The organizations study revealed interesting results.

Distinctions between primary care and emergency care practices may be influencing some insured patients' preference for emergency department treatment. The ability for primary care doctors to educate their clients about conditions that warrant emergency treatment and concerns about primary care physician availability may have influenced this trend. Also, the fact that emergency rooms are more likely to admit patients than primary care doctors may be another factor. Better communication could lead to more effective use of both primary care and emergency department services.

While technology has expanded the potential for general communication among medical professionals, there are still barriers. Speaking by telephone may be time-consuming for physicians and other medical staff. While other modes of communication-such as emails, text messages and facsimiles-may be convenient, they do not provide interruption-free exchange of information.

Real-time communication was not the only barrier. While shared electronic medical records were useful in obtaining patient history, they were not conducive for timely communication needed with emergency room visits. Insufficient time and lack of reimbursement were reported as significant barriers to communication as well.

As part of existing American health care culture, those who are insured are more likely to seek emergency room care. By 2019, health care reform will provide coverage for an additional 32 million Americans. This existing trend may result in additional burdens on emergency facilities and medical professionals even if situations are non-emergent and can be handled in a primary care setting. In the absence of sharing information, patients may be prescribed incorrect medications or receive unnecessary treatments.

Policymakers should not be the only people taking the lead in improving health care delivery. Patients may suffer adverse outcomes as a result of poor physician-to-physician communication. Those who do should seek advice from competent counsel to protect their legal rights.

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