Over my 23 years in practice, I have had many experiences where the disconnects in our medical system have negatively impacted patients, health care professionals or the health system. It was so dysfunctional that I started a Divisions Project in 2012 focussed on improving communication and coordination between the silos of the medical system. We thought the project might last a few years but we continue to find and try to address communication gaps.
The most recent experience relates to a disconnect between Community Family Physicians and Hospital-based Medical Imaging. I had a patient with significantly abnormal blood work indicating an intra-abdominal pathology. I was able to get the initial urgent imaging required within 1 week. The recommendation was to get further urgent imaging which was discussed with the radiologist and ordered. After 1 week, there was no response so we called the radiologist again. After another week without a response, we re-sent the referral as we had no confirmation that the referral had been received and triaged.
We then received a response from Medical Imaging telling us not to re-send referrals as it negatively impacts patient care (but we had yet to receive written confirmation that the referral had been accepted and triaged) and then 2 days later received an appointment date for THREE MONTHS after the referral date. We called the Specialist on call and were recommended to send the patient to the Emergency Department for admission to hospital to expedite the imaging. This is not an appropriate use of the Emergency Department or inpatient hospital beds, nor is it patient-centered care, but it was all we could offer.
The patient died a few days later. It is unlikely that treatment would have saved the patient, given the extent of the pathology, however, the patient’s final weeks of life were spent anxiously awaiting further imaging to identify the specifics of the disease and understand the options for care. If we had appropriate communication and booking timing for community referrals (compared to having to admit the patient for the workup), this patient could have had the information they needed to decide how they wanted to live their remaining days, and how they wanted to die.
This was heartbreaking for the patient, their family and all the care providers involved.