Good two-way communication is an essential element in successful doctor-patient relationships. But a communication breakdown between treating GPs can result in poor patient care and missed diagnosis.
Patients often see a variety of general practitioners for their various health concerns – for example, a patient might see their trusted GP for primary care, a GP skin specialist for skin lesions and a female GP for women’s health issues.
From the patient’s perspective, they feel they are getting the best possible care with each chosen doctor providing a “specialist” level of care for their area. The danger comes when GPs work in silos and do not communicate with each other. This can result in no one GP having a complete overview of the patient’s health.
Communication prevents fragmentation
In a recent case before the Medical Council, a 30-year-old patient had two treating doctors – his regular GP and his skin cancer GP. A few years previously the skin cancer GP had treated the patient for melanoma. Neither the skin cancer GP nor the patient had informed the patient’s regular GP about the melanoma.
In an appointment with his GP, the patient mentioned a lump under his armpit. The patient again did not mention his history of melanoma. The GP, not knowing the patient’s history of melanoma, checked the armpit but dismissed the lump.
At the patient’s regular appointment with his skin cancer GP four months later the doctor detected the lump and ordered a biopsy which confirmed a diagnosis of metastatic melanoma.
While there is a Medicare requirement for communication between a GP and specialist, this is not mandated when a patient is seeing various GP’s and GP’s with special interests. Just because it’s not a requirement, however, does not mean communication is not necessary and should not occur.
Doctors and patients are often in a rush. A patient may not give a full history, nor understand its relevance. Some patients do not want to admit to their regular GP that they see another GP for skin cancer checks or other health matters.
To prevent significant health concerns “falling between the seats” it is important that doctors take the time to take a full patient history, ask questions and communicate with other treating doctors.
Take away messages:
- What may seem an obvious or simple diagnosis, is not always the case.
- If in doubt, ask questions, and when you’re done, ask more – a comprehensive history is essential in being able to diagnose patients correctly. A patient may see a symptom as unrelated and not overtly mention it, which could be the missing piece to making a comprehensive and correct diagnosis.
- Pick up the phone – communicate with colleagues, ask the question, consult your peers, ensure you have the full picture.
- Review of Medicare Locals listed a key finding as patient outcomes can be improved by an organisation that reduces fragmentation of care.