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Physician-to-physician communication best practices

  • 1.  Physician-to-physician communication best practices

    Posted 05-03-2021 14:56
    Dear all,

    I'm looking for best practices in physician/provider to physician/provider communication, specifically with regards to inpatient consultations.

    Do any of you have tools for measuring good communication practice in this setting?

    In my mind the ideal state is a telephone conversation to pose the clinical question with the consultant, and a telephone conversation with the assessment and recommendations from the consultant to the primary provider. Logistically this is very challenging, so I'm curious if any of you/your institutions have developed best practices to guide this type of communication. Feel free to email me separately also.

    Thanks for considering!

    Shanu

    ------------------------------
    Shanu Gupta MD FACP

    Associate Professor

    Division of Hospital Medicine

    University Of South Florida

    Tampa General Hospital

    5 Tampa General Circle

    HMT 750

    Tampa, FL 33606

    Phone: 813-844-4891 |Fax: 813-844-1934

    Email: shanugupta@usf.edu
    ------------------------------


  • 2.  RE: Physician-to-physician communication best practices

    Posted 05-10-2021 09:40
    Hi Shanu,

    I am a PhD Candidate at Rutgers University and my area of study is patient-centered communication. Unfortunately, most of the work on patient-centered communication or patient-provider communication more broadly focuses on interactions post diagnosis. I may be biased, but I think communication is perhaps most important during the diagnostic process, as this is typically when the majority of patient-provider communication happens (e.g., HPI). I am hoping to change this.

    I have a few resources that may nevertheless be informative. There is some literature situated in the language and social interaction (LSI) subfield of communication on both the problem presentation and history taking phases on the clinic encounter. However, another critique of this work is that a large part of the work that has been done has been confined to the primary care setting. Alternatively, there is some work in the oncology/hospice setting about breaking bad news and empathic communication with patients/families--though not in the context of diagnosis, but perhaps this clinical setting is more relevant. Please email me if you are interested in the literature in any of these areas and I'd be happy to send them along to you.

    Best,
    Allyson

    ------
    Allyson C. Bontempo, MA (she/her)
    PhD Candidate / Instructor
    School of Communication & Information
    Rutgers, The State University of New Jersey


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    Allyson Bontempo
    Rutgers University
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  • 3.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 08:52
      |   view attached
    Hi all,

    This is SUCH AN IMPORTANT TOPIC! Speaking my language!

    I have found this organization to be a great resource: https://achonline.org/
    On the site, select Resources -> Academic Articles. There are several categories that apply to consultation, inter-professional communication, etc.

    I'm assuming you're already familiar with the 10 commandments of consultation? See attached for the updated article. From it, you'll see it's still broad in the literature, rather than specific best practices. I think it highlights that there is a lot of variability. Relevant Key Terms that come to mind are "transitions of care" and "teamwork," plus specific diagnoses, like heart failure. Also, Improving Diagnosis in Healthcare has some context about systems' best practices/standards, but I don't think there are specific tools.

    Perhaps this is an area we need to learn more about? Anyone else have ideas? Love this topic...

    Allyson - I'd love to see those LSI resources!

    HH

    ------------------------------
    Heather Hofmann
    Cleveland Clinic
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    Attachment(s)



  • 4.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 09:24

    It is an important topic and one in which we struggle with assessing effectiveness and then planning improvement efforts.  To that end, we are wanting to  give a 360 degree survey to our providers to assess their satisfaction with provider to provider communication related to each group on our medical staff.  Our hope is to establish a baseline and begin focusing improvements efforts.  Has anyone done that and have a good survey tool created?

    Thanks!

     

     

    Jeanann P. Pardue MD FAAP

    Chief Quality Officer

    East Tennessee Children's Hospital

    w-865 541-8663  c-865 660-1681

    jpardue@etch.com

     

     

     






  • 5.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 09:31
    As an outpatient physician, I have found it SO DIFFICULT to get another outpatient physician to return my calls about a recent visit re mutual patient.  I have found others delegate that to their staff who were not even in the examination room.    I have had a Medical Asst say recently, 'Well, I can read his note to you...' [Not blaming the MA, they were set up - but that is craziness.]





  • 6.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 10:15

    Hi all

    I was the site PI for a study funded by AHRQ to evaluate hospital discharge communications and how to improve communications to prevent readmissions.

    Our results were published on the AHRQ website.

    Although the study was focused on how to improve discharge summaries and communications with primary care to prevent readmissions our framework can apply to many other aspects of physician to physician communications.

    You all may find it helpful.

     

    Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care Final Report

    https://www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-finalreport-update-2021.pdf

     

    The Five Principles of Effective Primary Care-Based Care Coordination for Reducing Potentially Preventable Readmissions

    https://www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-reportaddendum.pdf

     

    1498684070639_Ted

    Ted E. Palen, PhD, MD, MSPH

    Diplomate American Board of Internal Medicine

    Diplomate Clinical Informatics American Board of Preventive Medicine

    Senior Investigator | Institute for Health Research | Kaiser Permanente Colorado (KPCO)

    Physician Reviewer, KPCO Member Appeals | Colorado Permanente Medical Group

    Assistant Professor, Kaiser Permanente Bernard J. Tyson School of Medicine, Dept. Health Systems Science

    2550 S Parker Rd, Suite 200 | Aurora, CO 80014 | ( 303-636-2406 | cell 303-514-8126 | 7 303-636-2945

    Email: Ted.E.Palen@kp.org

    Assistant | Yvonne Graves | 7303.636.2907 | Yvonne.X.Graves@kp.org

     

     

    NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them. v.173.295  Thank you.






  • 7.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 12:52
    Thank you everyone for your insights! Great insights, really...
    Allyson, I had not thought about looking in the language and social interaction literature - I'd appreciate your references there, and I will email you separately for that.
    Ted and Heather - thank you so much for your input also, I will peruse the websites for more information.
    I love the idea of 360s - we've often talked about them in the context of residency training in the past, and I would find them immensely useful as a practicing physician now. 






  • 8.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 14:23
    Would a list of biases to communication with discussion be useful?

    Loyalty, regulatory, and litigation come to mind. But there must be many others.

    Sharing can be so valuable with patients, but it can also be valuable to further research.

    How to do that satisfactorily is a big challenge, but should be possible.

    Robert Bell, M.D.




  • 9.  RE: Physician-to-physician communication best practices

    Posted 05-11-2021 15:50
    The Academy for Communication in Healthcare may have some ideas or resources for this.  https://achonline.org

    ------------------------------
    David L Meyers, MD, MBe, FACEP
    Board Member,
    Society to Improve Diagnosis in Medicine
    Sinai Hospital of Baltimore
    Berman Institute of Bioethics
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  • 10.  RE: Physician-to-physician communication best practices

    Posted 05-12-2021 19:29
    Edited by Maria Dahm 05-12-2021 19:30
    Hi Shanu,

    I'm a linguist and health communication researcher working at the Australian National and echo Allyson's comments. Studying interactions in the diagnostic process with the aim to improve diagnostic safety and reduce errors is tricky, because we never know in advance if a consult will contain a diagnostic error. 

    I feel that in terms of content of interaction for physician-provider/ provider/ physician, using an ISBAR handover template might be a good tool (to assess completeness and structure of information) https://www.sahealth.sa.gov.au/wps/wcm/connect/d1746a804895f4969c03fc7675638bd8/clinicalhandoverISBARphonepad-PHCC-SQ-20110804.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-d1746a804895f4969c03fc7675638bd8-nwLimyc 

    there is more literature on phone conversation from the applied linguist space that could give some insights into interactional difficulties (e.g. https://www.sciencedirect.com/science/article/pii/S0889490613000963)

    Re biases mentioned, we have literally just published a discussion paper in PEC about "Interpersonal Communication, Cognitive Bias and Diagnostic Errors" that gives some insights into how communication strategies can impact bias and lead to errors. https://doi.org/10.1016/j.pec.2021.05.012 

    Hopefully something helpful in that mix.

    Best wishes,

    Mary

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    Mary Dahm
    Institute for Communication in Health Care 
    Australian National University 
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