Friday, October 25, 2013

What should I ask my doctor?

How to handle a medical handoff...advocate for yourself or a family member when heading home from the hospital or off  to a consult for specialty care.

This morning I completed an online continuing medical education course on medical handoffs.  I wasn't even sure of what this meant when I registered and embarked on the course.  Turns out that it's just what it says, namely the handoff of a patient's medical care from one professional to another, say, for example, from me as primary care provider to a specialist consultant, or from a hospitalist to me as one of my patients is discharged from an inpatient admission back into my care.  These handoffs are risky business (and so this course is sponsored by my medical malpractice company) if information is incompletely or inaccurately transferred. 

I can't tell you how many times I've been in this situation--a patient comes to my office for follow-up to hospital care, and the discharge summary is not available.  Sometimes, I've heard the history via phone from the doc in charge at the hospital.  Too often, I did not even know that the admission occurred. More than once, the patient does not know the names of the physicians that were in charge of their inpatient care, and, worse yet, may not even know their final diagnosis! You may be nodding in recognition because this has happened to you or a family member.

This course gave a nice summary of that which a patient should know on leaving the hospital.  With just slight adjustments, many of these items could apply to any handoff situation where more than one professional is in charge of any aspect of your medical care. 
  • What are warning signs of a relapse? (I would add that any change that alarms you is worrisome enough to inquire about).
  • What are side effects to look out for from new medications?
  • Whom should I contact in case of difficulty? (I feel like your primary care doctor should be available to advocate for you in this matter even if they are not fully apprised on the matters at hand)
  • Does my primary care doc know that I was in the hospital and that I am leaving?
  • Do I understand why I was hospitalized, what was the diagnosis, and what is the treatment plan?
  • What results are pending?  Whom do I contact to find out these results? (this is extremely important, and applies as well to outpatient tests ordered by a specialist; find out if the specialist or your PCP will be the one to get the results, and call them if you don't hear from them within a reasonable amount of time).
  • Have any new medications been reconciled with my usual medications?  How long must I be on these meds, and who will order refills?
  • Where, when, and with whom do I follow-up? 
On average, PCPs only hear back from hospitalists 10% of the time after their patients are discharged from inpatient care.  An estimated 60% of discharges are made before all the in-hospital test results are in.  The hospitalist may assume that the PCP will follow-up; the PCP may not even know that the test has been done. 

Be your own best advocate on behalf of yourself or a loved one; ask these questions and make sure you get answers!

1 comment:

kenju said...

Excellent advice, of course. When I was hospitalized for one night last year, I was in good hands, since the hospital made sure that my records were sent to my primary doctor. She also knew in advance of the admittance, because I called her office. The more lines of communication are open, the better off the patient will be!