I don't know your doctor

Very frequently, when asking patients about their medical problems, they will tell me the name of their specific provider. Sometimes this is a primary care provider; sometimes it’s a specialist. Their tone suggests that they assume I know who they’re talking about.

Me: What other medical problems do you have?

Patient: I see Dr. Johnson—you know, across the street—for my heart stuff. He did my angiogram last year.

Me outloud: OK.

Me internal monologue: I’ve never met Dr. Johnson, I don’t even know where the clinic is, I don’t know which hospital system he works for, I don’t know his schedule, and this specific information is generally meaningless to our conversation so please don’t tell me more details about Dr. Johnson.

My hospital system has over 5,000 providers. Surrounding health systems collectively have over 5,000 more. It’s not that patients are unintelligent; they just have a limited perspective and understanding of the system. The systems are bigger and more disconnected than they appreciate.

I only work nights. I routinely see the nighttime hospitalists who admit patients. I see cardiologists and surgeons who are on call. And… that’s about it. I literally never cross paths with primary care providers. I don’t know anyone who works in the urgent care centers near my ER. Our paths simply do not cross.

I talk to specialists on the phone for specific questions. This can include virtually any specialty, but besides hospitalists, surgeons, and cardiologists, the remainder of those folks almost never come to the ER in the middle of the night. Patients sometimes want me to call “their doctor” as if that person is just waiting to rush to the ER to see them. Unless that provider happens to be the one actually on call for their particular provider group, I’m not waking them up at 3 a.m. If they happen to have given the patient their personal cell phone—which sometimes happens—the patient is certainly welcome to call or text if they believe they have that type of relationship, but that’s a rare situation.

Primary care providers and urgent care providers don’t send me messages when they send patients to the ER. Sometimes they will call ahead for a patient, but this is actually quite meaningless. We don’t get notified of patients 99% of the time, and guess what? We handle whatever comes through the door regardless. Despite those rare calls from another provider, it doesn’t really change our workflow. Patients get triaged, and even if your primary care says you need to go to the ER (which is often incorrect), you will be triaged like everyone else who comes in the front door and every ambulance that arrives.

Not to mention that the phone call will be answered by a HUC or PSC (health unit coordinator or patient service coordinator—the person who answers phone calls, pages specialists, answers patient call lights, etc.). Sometimes a charge nurse takes the phone call. But I’m one of over a dozen providers working on any given day in the ER. HUCs and charge nurses change at shift change. What are the chances that a message from a clinic provider about something that may very well need the ER—but is not acutely life-threatening—will be passed along to the provider who actually sees the patient at whatever time the patient arrives, gets triaged, and eventually gets a room after a typically long wait?

My point is that none of that “calling ahead” matters and it just wastes time and resources. When I meet the patient, the transfer of useful information can actually begin. No one is acting on any of that information prior to that. We don’t reserve beds. You can’t skip the triage line. We don’t call specialists before patients arrive (except in critical traumas and very few medical emergencies if we have very specific information).

Patients also assume that somehow the results of all the tests in the ER get sent to their other providers. No such mechanism exists. There is no back-end automatic messaging that sends a message in the EMR to any provider when one of their patients presents to the ER. In the same way, a visit to a specialist doesn’t trigger a message to primary care or vice versa. I have to explain to the patient that their results and the documentation will be visible to other providers, but there is no automatic notification system.

It’s true that I can message other providers within my medical system through the EMR. However, that’s not generally the standard of care. Of all the things I have to spend time on, sending a personal message about follow-up is not high on my list of priorities. The chance that the provider on the other end will see it in a timely manner is exceedingly low.

I order consults to specialists for patients to follow up, and the system takes over from there. Those types of orders get funneled through whatever triaging system that particular specialty has set up, and someone “should” reach out to the patient. In a perfect world, that clinic triage person would review the ER visit and the diagnosis and arrange timely follow-up as indicated by the problem or injury. As an example with two different orthopedic injuries: Something like a tendon laceration of the hand should generally be seen within a few days. A meniscus injury could be handled in days to weeks.

So, I don’t know your doctor.