A phone call to remember: Physician writing contest honorable mention

My patient’s mother answered the routine reminder phone call and could barely speak the words.

“She died from meningitis.” Then silence.

When had it happened? Why?

How did our clinic not know?

A wise mentor

He was a retired military colonel, excellent pediatrician, and a dedicated clinician. He was well-respected by all the pediatric residents and the type of doctor you would want to look after your own child. He was usually at the hospital after the house staff had gone home for the day; and being on his team for the month meant outstanding teaching but longer hours and more detailed lists of things to accomplish.

Inpatient pediatric medicine during the winter months is a time of high turnover, when the volume of patients and paperwork can become overwhelming. Unlike other attendings, he insisted that residents personally call each primary care physician when their patient was discharged from the hospitalist service. It was not enough to speak to a nurse or fax the hospital summary.

I remember waiting on hold for long periods of time for a community doctor, only to relay the same information that had already been summarized in the discharge paperwork. And my gesture to communicate was occasionally met with annoyance from a busy pediatrician who was pulled away from their clinic schedule. As a resident, I silently questioned the usefulness of this time-consuming task.

Read more:The winners of the 2015 Physician Writing Contest

My first job out of residency was at a general pediatric clinic attached to a community hospital. I often admitted clinic patients to this hospital, but children who required a higher level of care or specialist consultation were transferred to a tertiary center.

Not infrequently, a clinic patient would be admitted to the “downtown hospital” without any communication back to my office. It was only when the patient came to the clinic for a follow-up appointment that I learned of their recent hospitalization. I thought back to residency and became nostalgic for those discharge phone calls, wishing I was on the receiving end of the communication.

It was nothing out of the ordinary-a first appointment with a baby who had been discharged from the neonatal ICU a few days earlier. She had been born at 32 weeks gestation and was a classic “feeder and grower,” leaving the NICU without chronic issues. I knew the family from looking after the older sibling and was happy that this baby, although premature, was gaining weight and healthy. She had received her first palivizumab injection for RSV protection in the NICU and I arranged for two additional doses in our clinic in the subsequent months.

A couple weeks later, a clinic administrator called the family to remind them that the baby’s palivizumab injection was scheduled for the following day. Her mother picked up the phone and could barely speak the words: “She died.” We were stunned. When had it happened? Why? How did we not know?

I called the tertiary care hospital and asked to be connected to the pediatric ICU. Had they cared for this baby recently? Yes. What happened to her? She was admitted with late-onset GBS sepsis and meningitis. Things didn’t turn around. She died. Why wasn’t I called? Why didn’t I get any paperwork? I don’t know. My office just called this mother to remind her about her deceased baby’s appointment! Oh.

NEXT: A breakdown in communication

Lessons learned

The breakdown in communication frightened me. Due to my lack of awareness of what had happened to this infant, our clinic’s well-intentioned attempt to connect with the family had left an already grieving mother with fresh sorrow. And beyond that was our shared bewilderment-both the mother’s and mine-that her baby’s pediatrician would not know about her daughter’s passing.

I was reminded once more of that respected mentor in residency, the one who insisted on direct physician-to-physician communication for every discharged patient. At the time, those phone calls seemed inefficient and of questionable value. Now I was fully cognizant of the importance of the conversations, however brief, with the patient’s primary care physician.

Never again did I want to be ignorant about a patient’s medical course during their time in the hospital.

I have moved on from that clinic but frequently reflect on that baby and her mother and the circumstances of our patient-physician relationship. I am now working as a pediatric hospitalist and have many opportunities to share my knowledge and experiences with residents and students. Most physicians have stories which illuminate the enormous importance of effective transfer of information among members of a treatment team.

While the vast majority of physician-to-physician communications serve to improve care, the occasional failure highlights how critical these interactions are. Despite the ease of electronic messages, I find that they can be easily overlooked in a rush to see patients and complete charts. In my experience, a minute on the telephone or in the hallway can clarify a patient’s management more than ten pages of typed text.

Now that I am the attending conducting teaching rounds and overseeing the residents, I insist that every patient’s discharge plan include a call to the primary care physician.

Sarah R. Glick, MD is a general pediatrician working in Livingston, New Jersey