When Doctors Don’t Talk to Each Other

I lived with the illusion for many years, that doctors communicated with each other.    After all, every time I call any provider, the automated voice tells me, if you are a physician press #1.  Presto! the conversation begins.

Recently, I had a situation where the lack of communication between physicians put a client of mine at risk.  Here is the story.

My client lives in Florida and visits his family in a Boston regularly.  His cardiologist/cardiac surgeon is in Boston and Florida.  About five months ago, he had some dizziness and slurred speech and went to a Florida hospital ER.  CT revealed a sub dermal hematoma.  The neurosurgeon on call came and although a pediatric specialist, said he would follow him.  Usual protocols were followed including stopping any anticoagulants which he took since his cardiac surgery several years ago.  He was released with the usual follow up appointments.

My client is excellent at following up on healthcare and uses me to get through the system as fast as possible.  The issue that occurred was that the bleed lessened but did not resolve.  This meant my client couldn’t resume many activities he liked, especially driving or restat anticoagulants.  He continued to have some unusual symptoms.  More CTs were done and the result was always hold the course.

Meanwhile, the cardiologists in Boston and Florida, were concerned that a clot could form.  They wanted to have a conversation on what to do for his care.  The cardiologist in Boston contacted me and asked if I thought I could arrange a conference call with all the players. He told me the neurosurgeon’s office had not even sent current reports or notes.  What a great idea.  I knew it would take some work but I was game.  I also got all the records and faxed it to him.

The cardiologist told me the reason he wanted a conference call was because his efforts to speak with the neurosurgeon went unanswered.  He said he had called multiple times and left messages.  He was very frustrated.

The call was hopefully going to include the cardiologist, neurosurgeon and primary care provider.  I was able to get a yes from everyone except the neurosurgeon.  I contacted his office, spoke with his nurse, and office manager.  The response was, he is very busy or he is on call.  I made multiple suggestions like putting it in his schedule for 15 minutes.

This went on for two weeks and then I received a call from the neurosurgeon.  He said to me, can we do the conference call now.  I tried to explain that the other doctors involved needed lead time but could he hang up with me and call the cardiologist in Boston.  He said sure.  He didn’t call.  I couldn’t understand why he called me when I had left multiple messages to contact the cardiologist with every number possible including the cell phone number.  Needless to say, the cardiologist was not a happy camper.

I spoke to my client who was beyond frustrated and scared about  his health.  The risk of a clot weighed heavily on him.  He felt the neurosurgeon was not be helpful and what should be done.  He had seen the neurologist who told him if the bleed wasn’t resolved he would need surgery.

This is what I did.

I emailed the Boston cardiologist and suggested we get my client to Boston for an evaluation by a neurosurgeon who he knew and worked with.   He told me in his hospital system, specialist work as a team and talk to each other.  Decisions are made as a team.   Within a day, he had spoken with the specialist and an appointment was made.  My client was seen within a week.

We are now at five months.  The Boston neurosurgeon was surprised that an MRI with contrast had not been.  She felt there was a need to find out if there was an underlying cause for non resolution.  My client went home and three weeks later had an MRI.  Here is where it gets interesting.

About 7AM, I got a frantic call from my client.  His PCP had called and said the MRI showed a tumor in the frontal lobe.  Nothing more.  I said we needed to get the results to the Boston neurosurgeon.  He said he would get the disc and send it. I contacted the PCP office and get a copy of the result.  What the PCP had not told my client was the report highly suspected cancer.

During this time I was in constant contact with the cardiologist, who felt it didn’t make sense.  And he was right.  When the neurosurgeon read the films, she said it was not a tumor but scar tissue, a rare occurrence but not life threatening.  What  relief and joy I felt for my client.

The question arises, why couldn’t the neurosurgeon in Florida have a conversation with the other doctors?  Maybe the MRI could have been done sooner.  The local chatter about the Florida hospital and specialty groups is they don’t communicate with each other or anyone outside.  I have to wonder why that has developed as the medical culture.  It can only do harm to patients as was th case with my client.  He had a risk of a clot and the conversation needed to occur if there were any options or were there other possibilities.

The neurosurgeon and his staff kept telling me he was just to busy.  What specialist in this current healthcare climate isn’t very busy?  It is not an excuse to slight your colleagues.  I have learned that there can be a pecking order in medical specialties which is damaging to communication.  Surgeons like to put themselves at the top with neuro and cardiac vying for the primo spot.  The culture of a hospital system like the one in Boston doesn’t support that thinking.  It is the team and all its players that are important.

What would have happened if my client had surgery?  Another unnecessary medical procedure putting him at risk.  I applaud those doctors and medical systems that support and encourage team work and communication.  It certainly saved my client.