Doctors need to do a better job collaborating on patient care


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  1. Adam Smith

    An excellent article. While we need pillory the ER physician, we should not praise him or her as “well-meaning”: based on a high-stress, one-off experience, he/she prescribed a medication for high blood pressure and told the patient to keep on taking it. White-coat hypertension is a well-known phenomenon and physicians aren’t to blame for that: it’s just human nature. But the ER physician did not take that into account, and did not consider the experience the patient was actually having. We all know that blood pressure can fluctuate significantly, especially in a stressful medical setting. We all know that blood pressure medication is dangerous because people’s pressure fluctuates. Prescribing such a medication from a one-off, very stressful experience completely is myopic at best. This was a medical error by the ER physician that fortunately did not have any long-term impact, but it could easily have done so (if she had fallen and broken a major bone or suffered a head injury, she would have likely died quickly thanks to the ER physician). Has the ER physician been informed of this mistake?

    • Ed Weiss

      Hi Adam,

      It may not have been completely clear in the piece, but it was actually an attending physician in hospital after the patient was admitted, not the ER physician. I did provide feedback to him but nothing much came of it. Unfortunately this has been the trend in several such instances in my experience.

      • Adam Smith

        Thanks for that clarification that the issue was with the attending physician, not the ER physician. Sadly that makes it even more frightening!

  2. Denyse Lynch

    Very good article. Just wondering who’s educating, informing, supporting, mentoring, coaching the doctors on these expectations?

  3. Padraig Dragovich

    This is a nice opinion piece, but not a lot more than that.

    While the CPSO continuity of care policy seems reasonable on the surface (but it’s not on deeper dive), it is simply an end-around to impose accountability and work on physicians without any pay. Regulation is not the way to improve quality of care in any working environment. That is a doomed to fail strategy. Taking some time to understand WHY continuity of care is fragmented and addressing those systemic issues would be a far more effective strategy.

    As for the anecdote, there is so much missing information, that it is impossible to know if it was a preventable patient safety incident.

  4. Henry

    That all sounds good but leaves me wondering about the old saying that many hands make lighter work. Isn’t a big part of the work load problem a lack of a sufficient number of Drs etc…

  5. Andreas Laupacis

    Thanks Ed. When I worked as a hospitalist, I used to tell our house staff that the most under-utilized diagnostic test was a call to the patient’s family physician. Unfortunately, we didn’t make one often enough, and sometimes when we did, we’d get an answering machine that said “We are not here. Please don’t leave a message – call back at 2pm”. I agree that in 2018 there should be more effective ways of timely communication.

  6. Maria

    Put the actual policy in the College survey to make it easier to complete and so I don’t have to open up two separate documents.

  7. Paul Conte

    You state “Many of the proposed measures are fairly uncontroversial” and then go on to list as one of those uncontroversial measures…”walk-in clinic doctors will need to notify patients’ regular family doctors of any visits to their clinics.”

    This is anything but uncontroversial. I own and work exclusively in a walk-in clinic. My default is to copy family physicians on all test results of investigations that I order. I suspect that you would be stunned at how many people refuse this and demand that their family physician NOT be copied on these results. Is this not their right to refuse this? Are you suggesting that a CPSO policy should override the basic principles of informed consent? Really? Uncontroversial? Hardly…

    • Ed Weiss

      Paul,

      I don’t think anyone, the CPSO included (though I can’t speak for them), is suggesting that we should override a patient’s explicit request to keep medical information private, and I’m not sure why you’re reading that into the CPSO’s policy. What’s uncontroversial, in my opinion, is the requirement to notify the patient’s primary care provider of the encounter and any associated diagnostic results, assuming that the patient consents to this. You may run a top-notch and highly responsible walk-in clinic, but many other clinics do not have the same strong commitment to information sharing; I often have to chase walk-in clinics for information and test results in order to properly follow up on patients’ concerns.

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