Stanley Frencher Jr's thoughts on how the question of "can you see my patient?" tells us all we need to know about the gaps in the care continuum. Read his post to see his recommendations for how we can keep patients healthy, and avoiding needless trips to the ER.
Can you see my patient? A question often posed to me as a urologist as if the decision is mine alone. Prior authorization processes, culture of defensive medicine, increasing complexity of healthcare conditions and insufficient time to address patients with multiple acute and chronic conditions has led to an explosion of referrals from primary care offices to specialists. We don't teach collaborative care models in our training. Consulting one another as physicians has devolved to an administrative task- a orderable in an EHR, a referral coordinator submitting an authorization request, a clerk faxing (yes, still faxing!) documents to an office, typically of little relevance to the patients condition. Additionally, there are too few specialists on the other end of this exchange who are under-paid by medicaid forcing many to push back on the request for help. Primary care physicians and specialists used to know each other as small groups and solo practitioners. They attended conferences together, celebrated holidays, got politically active and were pillars in their communities. I know because that's what my dad, a primary care physician, and his colleagues did. Our safety net, despite billions spent on medicaid has come to rely heavily on volunteerism and virtue on the part of some specialists chosing to serve communities in greatest need. While we can and should certainly applaud these heros, our charge as healthcare leaders must be to create sustainable opportunities for specialists to have an enriching career taking care of all patients irrespective of payer type. And currently, that simply is not the case. When starting our work in South LA, I was told that the gift you bring is not your expertise developed through years of training but your willingness to work in an environment not ideal for delivering high quality care consistently! So how do we change it? Culture shift- we must build ways for primary care and specialty care to work more closely together and build community amongst clinicians. Patients assume we have this. We don't. The work we do is not about building and integrating new technology. It's about building a new culture. One that relies on and leverages tools to strengthen relationships between members of the healthcare team to deliver better care. We started with eConsult and that was only the beginning. With a growing array of services aimed at filling the holes in our safety net through AI-enhanced, specialty care ambulatory triage, a growing statewide network of virtual and in-person specialists, integrated transitional care and behavioral health support, we aim to build the type of care that our most socioeconomically disadvantaged and geographically isolated communities deserve. When we have an ambulatory care system that our patients understand and can rely upon, they won't feel the need to go to the emergency room.