Getting Care Outside of My Office


One of the questions people ask is whether or not I see patients in the hospital.  I assume they aren’t are asking about my eyesight in the inpatient clinic.  I can see quite well in the hospital, thank you.  But what people are really asking is if my care extends to the hospital, or most importantly, will I still be their doctor if they are hospitalized?  The answer is yes, but not in the way people are asking.

One of the unfortunate things about care in the US is that it is divided up. There is very little communication, and even less coordination, between doctors working in the hospital, the ER, in specialty offices, and in primary care.  Each of us does our own thing like we are the only one caring for the patient. Obviously, people don’t take on different identities when they go to different locations of care, so why should the system treat them in that way?  In an ideal world we could get the different parts to communicate well and coordinate care, but people (including doctors) are lazy and don’t want to take the time to see what care has been done elsewhere or discuss the care with the other providers.  Some would argue that I should have used the word “busy” instead of “lazy,” and that may often be the case, but I’ve made information on my care of patients easily available to other doctors in a way that would improve care quality and even possibly make things easier, but I’ve yet to see this information used.

A solution in the hospital setting would be for me to take care of my patients when they are admitted.  The problem is that inpatient adult medicine is complex, time consuming, and something I haven’t done for a number of years.  Any advantage gained by me knowing my patients would be offset by the infrequency of my care for patients in the hospital.  So what’s the solution?  Is there a way to overcome this inevitable fracturing of care?  /The key to this is to remember that I am still your doctor, even when you are under the care of other doctors!/ When you are in the hospital, the ER, or at the specialist, I am still your doctor, your advocate, and a good source of information and advice.  The biggest benefit of paying monthly is that I don’t have to worry about being paid, so I won’t withhold care outside of the office.

So what does this mean?  Here’s what my patients should do if they are getting care outside of our office:
1.  Notify our office if you are admitted to the hospital or go to the ER. – We don’t need to know immediately, but sending a message via Spruce, sending an email, or leaving a message on our phone system will let us know things are happening.
2. Don’t assume we are notified of ER visits, hospitalizations, or specialist appointments. – That happens, optimistically, about 30% of the time.  The remaining 70% we find out in retrospect (like when you come to the office and tell us you were in the hospital for 3 weeks) and have to call for records.  It’s a broken system, folks.
3.  If you are confused in your care or feel frustrated in the hospital or ER, contact us!  – I can’t guarantee you I’ll get your message if it is 2 AM, and I won’t overtly second-guess doctors giving you care, but I can help guide you to ask the right questions, say the right things, and get better care.
4. Send us a quick message after each specialty visit and recap your visit.  It’s really helpful to get your perspective on things (often better than that of the doctor), and it puts us on the look-out for notes from them.

Too few people take advantage of this, and so end up frustrated and alone.  They fail to remember that our practice is totally different.  We work for our patients, are paid by them, and absolutely want to be there to help when they need it the most.  It may not be in person, but we are always a phone call or message away.  The system may not do well at continuity of care, but open communication between us and our patients can bridge the gulfs between different aspects of care.  It\’s one patient, so care shouldn\’t be divided.

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