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Whether we do it or let the “system” do it for us, effective communication can work!

Nekhlyudov

Let me share two recent experiences that led me to write this piece.  The first one involves a young woman who is a childhood cancer survivor.  She is doing quite well, continues to see her cancer survivorship clinician annually, but has become comfortable in being followed by me as her primary care provider.  I recently saw her for an annual physical, at which she had a normal examination and blood work.  A few weeks ago, she developed a swelling of a lymph node, and was immediately seen in our urgent care facility.  Her blood work showed non-specific abnormalities, but with no clear evidence for a cancer-related etiology.  I was not at clinic on the day of her visit, but when I arrived at the office the following day, I found a note from the urgent care clinician in our electronic medical record.  While I was somewhat reassured, I remained concerned about a possible secondary malignancy.  I called her to discuss the next steps and found out that she already arranged a visit at the survivorship clinic.  Knowing her clinicians there quite well, I contacted them to review the case.  After her visit, we again emailed and arranged a plan for follow up.  Upon my re-evaluation, secondary cancer remained on my differential.  Yet, taking the "common things are common" approach, I tested for mononucleosis and to my relief, the test confirmed by suspicion.  Now three weeks later, the patient continues to feel better, her lymph node has resolved and her labs have returned to normal.  During these weeks, her survivorship clinicians and I remained on top of her care and while we have not formally inquired, I suspect that the patient feels assured that we are familiar with one another, communicate regularly, and as a team, carry out an agreed upon plan of care.    

The second involves a woman with metastatic breast cancer who receives ongoing treatment from her oncologist and sees me several times per year for management of her non-cancer care.  I was out of town for a meeting when I received an email (promptly delivered to my smart phone) with a visit note from her oncologist's office.  She was found to have neurological symptoms, a CT scan confirmed a metastatic lesion and she was directed immediately to the hospital for possible surgical excision.  Over the next several hours, I received a series of automatic hospital alerts notifying me that she was admitted to the neurosurgical service, scheduled for surgery, completed surgery, transferred out of the neurosurgical service and onto neurology.  Two days later, I received an email notifying me that she was discharged to a rehabilitation facility.  I was surprised by the level of automatic communication I received but grateful that the hospital system kept me in the loop during these eventful days in her care.  Upon my return to the office, I called her at the rehab and let her know that I thought of her during these days, and that I am so relieved that she pulled through. 

We often share stories about the breakdown in communication and lack of coordinated care.  I hope that these stories showcase effective communication, whether facilitated by clinicians themselves or by the "systems" in which we practice.

Larissa Nekhlyudov, MD, MPH
Harvard Medical School/Harvard Vanguard Medical Associates

Written by CCRC at 10:32

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