Despite the emphasis on individual accomplishment and testing we were subjected to during medical training, medicine is inherently a team sport. It can actually be quite similar to being a mom and a wife — marriage and parenting being two other team sports. Just like at home, despite the best intentions of all parties involved, conflicts and role confusion inevitably arise when caring for patients.
Sometimes diagnostic testing ends up in a no-man’s land. Is it the responsibility of the doctor who did the test, the doctor who ordered the test, the doctor who interpreted the test, or the primary-care doctor? It can be hard to say at times, and unfortunately, we already know that hand-off is one of the things at which our medical system performs the most poorly. It’s equally awkward to call a patient and realize that you’re the second or third person to call with the same result as it is to be facing a patient in your office who never received the results of a test done a month earlier.
As our patients’ healthcare becomes increasingly specialized and fractured, more and more gaps are opening between the providers caring for them, sometimes with disastrous results. Hospitalists may order testing, such as a CT scan or a nuclear medicine scan at hospital discharge. The expectation is that the patient will follow up, as instructed, and the results will be reviewed with them by their primary-care doctor. Unfortunately, patients don’t always follow up and primary-care doctors don’t always know to look for a test they didn’t order.
Having a set way of doing things seems to make the most sense. At my house, I’m responsible for the laundry and my husband is responsible for the grocery shopping. If someone doesn’t have clean underwear, it’s on me. If we run out of milk, it’s on him. However, dividing patient care is not nearly as easy, just like parenting often involves overlaps and under-coverage.
As a primary-care doctor, I feel tremendous responsibility to my patients as they traverse the health care system. A patient of mine was recently diagnosed with cancer. Her PET scan is concerning for distant metastases. The doctor who ordered the test didn’t return her anxious family’s phone calls for days. Do I step in and give the result, even though I don’t know all the implications or the plan for care? Do I wait for the ordering physician to disclose the results in his own way? Should the radiologist be the one to give the results, as she is the first to be aware of them? I can pose an argument for each of these approaches.
However, just like laundry duty and getting the kids dressed for their holiday concert, I take my primary-care responsibility very personally and very seriously. I want to be the one to give the all clear on a normal CT scan or to hold a hand while I give bad news.
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