When doctors don’t talk to each other

Stephanie Garcia, M.D.

As more options become available for where and how patients receive care and treatment, it’s never been more important to have clear communication between primary and specialty care providers. Unfortunately, open, timely communication does not always happen due to busy schedules, overworked practice staff, and a lack of established communication protocols.

Poor communication between primary and specialty care has been an ongoing problem. According to a 2022 study, physicians “do not consistently communicate with each other about the patients they share…despite the availability of technology [EHRs] to aid communication and despite incentives to improve care coordination.” The study goes on to say that nearly a quarter (22%) of primary care physicians (PCP) “sometimes” or “seldom or never” sent clinical information to specialists at the time of referral, and more than one-third (35%) “sometimes” or “seldom or never” received information back from specialists after consultations.

Why is effective, timely communication between primary and specialty care essential?

When communication between the PCP and specialist is absent, risks arise. For example, insufficient communication increases the chances of duplicative care, such as when the primary and specialty care provider orders the same tests or treatments instead of reviewing the ones that have already been ordered. Mistakes like this can negatively affect clinical, financial, and operational outcomes.

Similarly, communication shortfalls can delay diagnosis. This could happen when the two physicians pursue different courses of treatment, don’t share information about what’s been tried and ruled out, and fail to reach consensus on the correct path forward.

Ultimately, if not resolved, communication deficits can lead to inappropriate, contradictory or insufficient care. Which of course, is ultimately detrimental to the patient’s health.

Strengthening communication does not have to be difficult

With just a few intentional actions, listed below, primary and specialty care providers can open lines of communication to help prevent the negative ramifications discussed above. However, it should be noted that asynchronous care is only achievable, when both primary and specialty care parties are willing to participate. To ensure effective communication it’s important to:

• Establish relationships with other providers.

Although it may seem obvious, making connections with other physician practices is probably the best way to ensure effective communication. Both primary and specialty care practices should make sure they have a designated contact with whom they can connect quickly if rapid information exchange is necessary. This may involve reaching out and asking for a contact person and supplying one in return.

• Own the communication.

Primary care doctors are often the chief drivers of communication; however, specialty care providers can also own this work. Each party should assume the responsibility of sharing what the other party needs. For instance, primary care physicians should provide specialists with pertinent information about the patient’s condition and why there is a need for a consultation. They should also share extenuating circumstances or questions; medications, laboratory results and imaging for chronic condition patients; and previous referrals. The primary care physician must ensure the patient is aware of the specialty care appointment and why it’s necessary, so the patient and family are not surprised or confused when they arrive at the specialist’s office.

In return, specialty providers should make sure they offer timely appointments; share consultation information in a timely manner, preferably within two weeks of a visit; and communicate and collaborate with the primary care physician (PCP) before developing a continual treatment plan and/or referring to other specialists.

• Don’t let poor communication become an acceptable reality.

Despite best efforts, it still may be a struggle to communicate with other providers effectively. It’s important not to lose heart and accept that poor communication is a norm that can’t be changed. In my experience, most providers appreciate a gentle reminder—and that is frequently the push they need.

My practice has developed a contract of sorts to help convey expectations and demonstrate our commitment to open communication. The short document outlines important actions required from both parties to develop better communication habits, such as sharing patient information, setting expectations for a consult visit, initiating phone calls when needed, and other fundamental responsibilities that create PCP-specialist synergy. We send this to providers when we are having trouble communicating, and we have found it to be effective at fostering better information exchange.

• Look beyond referral specialists.

Many of the ideas discussed here can apply to other providers as well. For example, there is value in setting up relationships with hospitalists and providers who work in skilled nursing facilities. This allows primary care practices to respond quickly when a patient is discharged from the hospital to prevent readmissions.Make sure there are processes for connecting with and sharing information with these providers to mitigate the risks of miscommunication or insufficient communication.

A commitment to collaboration is paramount

While poor communication between providers has been a longstanding problem, progress is possible. As providers continue to put the patient at the center of everything they do, effective communication across the continuum becomes more of a priority. When primary, specialty, and other providers make the commitment to communicate better, they can foster collaboration and deliver optimal patient care.

Stephanie Garcia, M.D., is a board certified Family Medicine physician. She finished her undergraduate work at The University of Texas at Austin, before going on to study at the McGovern Medical School at The University of Texas Health Science Center at Houston, and completed her residency at Memorial Southwest in Houston, TX. She is a board member for Valley Organized Physicians.