Communication between primary care physicians and consultants
R. M. Epstein
Program for Biopsychosocial Studies, Highland Hospital Primary Care Institute, University of Rochester, NY, USA.
Optimal communication between primary care physicians and consultants
includes transfer of relevant clinical information, including the patient's
perspectives and values, and provides a means of collaboration to provide
meaningful and health-promoting interventions. Communication difficulties
arise because of lack of time, lack of clarity about the reason for
referral, patient self-referral, and unclear follow-up plans. Also, primary
care physicians and consultants may have different core values and may have
little day-to-day contact with each other. Poor communication leads to
disruptions in continuity of care, delayed diagnoses, unnecessary testing,
and iatrogenic complications. Changes in the health care system offer the
opportunity for improved collaboration between physicians by creating
smaller administrative units within large health care systems that
facilitate contact between primary care physicians and consultants;
incorporation of discussions of uncertainty, patient preferences, and
values into referral letters; adoption of a friendlier consultant letter
format; and the improvement of the transfer of clinical data.
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