American College of Physicians: Internal Medicine — Doctors for Adults ®

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Improve feedback with subspecialists

From the November ACP Internist, copyright 2010 by the American College of Physicians

It is not uncommon to hear complaints from physicians regarding the poor communication between general internal medicine practices and subspecialists. For example, general internal medicine physicians might complain about not receiving feedback in a timely manner, while specialist might report that they didn't receive essential information to answer referral questions.

An ACP policy paper, “The patient centered medical home neighbor: The interface of the patient centered medical home with specialty/subspecialty practices,” focuses on general internal medicine practices and their practice “neighbors” to whom they refer, as well as the need for increased communication and collaboration to ensure the delivery of high-quality, effective care.

Research shows that interactive communication between primary care and specialists is associated with improved patient outcomes. So how can general internal medicine physicians facilitate better communication and collaboration with colleagues? Here are a few suggestions.

Interact with and get to know the physicians you refer to and from whom you receive referrals. This type of social activity used to be an important part of hospital staff membership that has become less common with the growth of the hospitalist movement. These informal interchanges facilitated communication of clinical information, provided opportunities for curbside consults to help avoid unnecessary or unproductive referrals, and clarified expectations regarding the general referral and response process. Thus, mechanisms are needed to replace these currently less available contacts. For example, you can make a point of having lunch once or twice a year with your frequent referral or referring sources to both socialize and generally discuss the nature of your collaborative processes.

Develop care coordination agreements between you and your network of collaborating practices. These agreements, often employed within integrated care networks, formally clarify expectations regarding the referral process among practices. ACP's policy paper provides a set of aspirational principles to be used in developing these agreements and examples of their implementation.

It is clear that increased communication and collaboration are an important part of delivering effective care. Take some time to formulate how your practice can improve.

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Additional reading

American College of Physicians. The patient centered medical home neighbor: The interface of the patient centered medical home with specialty/subspecialty practices. Philadelphia: American College of Physicians; 2010.

Bodenheimer T. Coordinating care—A perilous journey through the health care system. N Eng J Med. 2008; 358:1064-71. Available online (subscription required).

Foy R, Hempel S, Rubenstein L, et al. Meta-analysis: Effects of interactive communication between collaborating primary care physicians and specialists. Ann Intern Med. 2010;152:247-58. Available online (subscription required).

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