Monday, July 1, 2013

A Non-Heroic Act

This is from a comment I originally posted on at
Recently, a patient who was away on vacation paged me with very worrying symptoms. I told her to go immediately to the nearest emergency room. I then printed out and faxed an automatic face sheet containing her diagnoses, medications, adverse drug reactions, and most recent vitals and labs. Next, I called the emergency room to which she was headed and briefed the attending physician. This physician later informed my patient that my 'remarkable' handoff was part of what saved her life.
This should not have been a 'remarkable' handoff. My electronic medical record system should have sent most of the relevant information automatically and instantaneously even had I not been near a fax machine and had not had immediate access to the medical record and a printer.
In every other aspect of society, your privacy is for sale to anyone who wants to violate it. Only in medicine, where effective information exchange done in your own interest can save your life, is privacy protected so jealously. Medical information 'siloing' (maintaining medical record systems that do not talk to each other) creates endless administrative costs, delays, redundancies, and avoidable errors. This means everything from visit notes to radiology, current and previous med lists, adverse drug reactions, diagnoses, other providers' contact information, patient contact information and next of kin. Don't think communication of this information is important? How well do you think a hospital would work if, every time a new doctor walked into your room, they had to gather and record all of your information from scratch? How much extra time and money would they burn gathering old facts? How much more likely would you be to die? If it makes no sense within a hospital, it makes no sense between hospitals.
Sophisticated patients can mitigate this somewhat by keeping their own copy of important health history, but if you have had a serious illness, your history quickly becomes immensely complicated. It is hard for even a medical professional to always know what parts will be important. This is nothing compared to the challenge for patients who are just not sophisticated in the ways of medicine or computers or for the people who tend to be the sickest--those who are demented or otherwise intellectually or psychiatrically impaired.
Getting my patient's information to that ER physician was no heroic act. It was doable because I happened to be in a location where the information was easily accessible, and I had the time and means to transmit it. But, unfortunately, such handoffs are not common. They should be.