Dr. Pantilat, who is associate professor of clinical medicine and director, Palliative Care Service and Palliative Care Leadership Center at UCSF, theorizes that when interacting with colleagues such as other hospitalists and physicians, nurses, social workers, case managers, and pharmacists, poor communication skills can make the physician’s work tougher. “Poor communication makes your life difficult with your colleagues,” says Dr. Pantilat. “People don’t like talking to you or interacting with you … and your job can generally be more difficult.”
Post-Discharge Communication
In the traditional medical model, a primary care physician would see patients in her/his office, the hospital, or rehabilitation. With the expansion in hospital medicine, patients are now “handed off” and seen by a number of providers. Hand-off fumbles can mean critical information may be lost, leading to poorer outcomes and greater readmission rates.13-15
Forging and maintaining effective communication with colleagues following the discharge of patients is an area where few in-house physicians do well, says Dr. Vidyarthi, who has it on her agenda to tackle this “huge problem” for her institution in the coming year. There are two pieces to that problem, she says. One is to accurately identify the patients’ primary care physicians and the other is to make contact with them.
“You could page them, but they’re in clinic, and they can’t take five minutes out when you can’t take five minutes out,” says Dr. Vidyarthi. “The communication with the primary care physician is actually a field in and of itself.”15
Part of her plan is to devise some means of “physician-independent generated communication,” perhaps a letter or e-mail sent from the hospital to report to a primary care physician that his/her patient has been admitted to the hospital.
“That raises a flag to that primary so they can try to find the hospitalist, which is usually very easy … because we’re always in the hospital,” says Dr. Vidyarthi. “And it’s the first stage of the communication: Now that person is aware. If I can find them, if I can access them, they’ll be able to take that time out, because they know their patient’s there.”
In her work as a senior fellow at the Center for Health Professions at UCSF, Dr. Vidyarthi strives to “embed communication into the larger framework of organizational change.” And what does a hospitalist do if an institution’s post-discharge communications system is not up to par? There are three basic things you can do to help overcome this source of frustration, she says. The first is to continually build relationships with primary care providers.
“If I send an e-mail to somebody and they know who I am, they are much more likely to respond to that because they know me,” says Dr. Vidyarthi.
Next, find a system that works for you. “Don’t wait for the rest of the systems to be put in place,” she says. “This is about personal practice. And if that means you take five minutes in the morning to send an e-mail or five minutes in the evening, whatever it is, find [a system] that really works and figure out a way to evaluate it.”