The Patient’s Role in Outpatient Care Handoffs
I was the kid that cried, begged and bargained to avoid venipuncture. I was notorious for bartering certain veins in order to disallow less desirable locations. Like my wrist—I would never allow blood to be drawn from such a vulnerable place where I maybe innately understood there to be important structures that I preferred remained undisturbed.
Now I spend much of my time on wards pouring over the daily lab values of my patients. Click click click equals a morning venipuncture for a sleeping child who didn’t want to be in the hospital in the first place. Click click click and we have to redo the chemistry panel that hemolyzed.
Though I’m trained to be thoughtful about ordering labs for which I actually need to know the values, I am also trained in the principle that belies pediatrics in particular: the economy of pokes. The fewer the pokes, the better. It’s the stuff of patient satisfaction and good bedside manners to remember that labs mean forcing a needle into the most vulnerable parts of your arm to extract just a teaspoon of that lifesaving organ, blood.
In pediatric specialty clinics it is completely normal for our patients to arrive with a relevant chief complaint and a vague story of labs that have been drawn but all came back normal, or didn’t come back normal, or they never saw the results, and here they are at their first visit to GI clinic without any documentation to show what the previous work-up has demonstrated. This is a huge burden on the patient experience, on providers and on the system as a whole because inevitably the same labs must be repeated for the work-up to continue under the purview of a new doctor. We trust but we also verify because a misinterpreted result can cost us a diagnosis. Click click click and we have to get repeat labs, the child has to undergo the trauma of repeat needle exposure, and someone – parents, insurance, the system—has to pay for the same information to be re-extracted, re-measured and re-input.
We don’t live in a country with a universal electronic health record to transmit this information from doctor to doctor on our behalf. Who, then, must carry this vital health information between doctors? Patients (or in my case, parents) should be responsible for communicating between doctors what work-up has been done.
This does not mean that patients are expected to interpret their results—however, they should be able to produce a copy. A patient that does not have documentation on previous work-up that has been done is not a lazy or non-compliant patient; more often this is a symptom of having faith that the health care system that is less fragmented than we, as doctors know it to be.
One of several missing links here is the actual conversation between providers and patients about their individual roles and responsibilities. This means for patients that their role is to bring their pill bottles to new appointments or non-emergent hospitalizations and that they keep records of what has been done to measure their personal health. This is not an easy task. It also warrants an ongoing discussion of what data is worth keeping in a binder or in an app on their phone and what data is less vital to ongoing care.
In a system in which roadblocks to communication between doctors is the norm and systems enabling easy access to communication are the exception, it is reasonable to set the expectation that patients can have less frustrating experiences when they are empowered to take a leadership role in their care. The problem arises when we don’t admit the failure of the system, when we don’t communicate their and our role in their care, or we make it far too hard for them to gain access to their health information.
American Resident Project fellows receive compensation from Anthem for sharing their perspectives on this blog. Fellows views are their own and do not necessarily reflect the views of Anthem, Inc.