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Sending Out an SOS

Quite often, as we see our patients in the outpatient practice, or pick up new patients from an inpatient admission, we are faced with the unusual task of having to remind ourselves to do something 3, or 6, or 12 months from now.

Often, when a patient gets a test, the result comes with a recommendation to repeat the same test in a certain amount of time off into the future. Finding the right way to do this has always been a challenge, and in many ways the advent of the electronic medical record has streamlined some of this. I have many colleagues who keep electronic planners or old-fashioned notebook planners, and often write these little notations to themselves on the calendar date 3 or 6 months hence.

Somehow, I’ve never gotten used to using any of these newfangled gizmos. I bought the first Palm Pilot many years ago, and would come home at the end of the day without ever having remembered to turn it on to check my schedule and to-do list. I would faithfully buy the new insert for my beautiful cobbled-leather Filofax planner every December, and then the following December look back on all the empty white pages. Recently I have tried a number of different apps — even cool devices that allow you to write on paper and have it magically transferred onto your device through Bluetooth — but even these end up benignly neglected.

I remember long ago leaving myself little notes taped to my desk — and later, sticky notes pasted to the edges of my computer monitor — with little reminders: “Don’t forget to order a CT scan on Mrs. Jones in March” or “Call Mr. Smith to come back in to repeat his thyroid tests 6 weeks off.” Not ideal.

Now, there’s new functionality in the electronic medical record that allows me to future order a scan for certain date, and go ahead and have it put on the radiology schedule, and the patient will get an automatic reminder that they have an upcoming appointment for this scan 6 months from now.

I can also send myself a reminder into the future — “Don’t forget to call Mr. Green who started on an antidepressant 2 weeks ago to see how he’s doing.” The electronic message will fly off into the ether and hide somewhere, waiting in the cloud for its appointed time to pop back into my in-basket.

And I think there are even ways to conform the system so that I can send a patient a reminder in the future as well. This can take the form of a reminder to come back in for a repeat blood count or thyroid function tests or repeat fasting cholesterol, and even other things that I want to bug them about, such as sending me their blood pressure readings or blood glucose results through the portal, or letting me know how their new exercise regimen is going.

Right now, when a patient gets a CT for lung cancer screening, they are automatically entered into a registry that tracks them, and they send me a reminder 12 months from now that the patient is due for their follow-up scan. Hopefully we can move to have the patient reminded of this as well, so all bases are covered.

I think it would ultimately be amazing, as we move towards a more patient-centered shared decision-making model of care, if every result came with a set of recommendations for when and why to repeat, so that we could better inform our patients. For instance, for some thyroid nodules on an ultrasound that are deemed not needing a biopsy now but are worth rechecking in 6 months, the primary care doctors, the patient, and the ultrasonographer should all be able to join together in a discussion about the risks and benefits of proceeding with this recommended course. Then we can find a way to put this on everyone’s schedule, so that nothing falls through the cracks.

For ultimate patient safety, we meet need to make sure that all results are followed up on, that everyone is informed about what was found — every result, every test we do, every scan, and every procedure — and all involved parties know what their responsibilities are for making sure that the loop gets closed and all appropriate follow-up gets done.

We’ve all seen bad outcomes when patients come to us and tell us they had a test done by some other provider, but they never heard the result, so they assumed everything was okay. “No news is good news, I guess,” they often say. We’ve all seen this not end well. Or when one provider thinks someone else was going to follow up on this, when that’s exactly what the other provider was thinking.

We need to find a way whereby every result gets communicated to every patient, and they clearly understand what needs to happen next, when it needs to happen, and what this test result means for them, now and in the future. What their job is, what our job is, and who’s responsible for what.

The message needs to be clear.

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.

Source: MedicalNewsToday.com