I read this paper with deep interest as a secondary care physician & experientially support its notion.
Whilst I do get concerned when (inpatient AND outpatient) referrals start "well known to Dr..." since that is often code for lowered interest & application by the referrer, it is absolutely true that past knowledge of a case is very valuable indeed (as are old notes, & of course is reading them!!), not just in primary care. With the limitation of 10 minutes to the GP, it is very obvious when the physician has been unable to fully acquaint themselves with the situation when it is the first time they have met the patient.
The target culture putting haste as the only measure of performance fuels this (& indeed some patients seek out the novice or locum for secondary gain). This is no different when patients come 100 miles to see me via Choose & Book, rather than see their local expert who has known them for 10 years & has full access to scans & tests without the data protection restrictions I do perhaps a week or few later. I can discharge cases I know on the same day from the EAU or the Clinic, ultimately completing the Consultant Episode more quickly & at a much lower cost.
Coalface GPs know this well of course, but the drivers at play for emergency & scheduled care make it impossible for my poor primary care colleagues, as does the time restriction they have to see an individual. Tortoises live longer than hares & accrue knowledge (about their patients).
Rapid Response:
Re: Familiarity breeds better outcomes
Sir/Madam
I read this paper with deep interest as a secondary care physician & experientially support its notion.
Whilst I do get concerned when (inpatient AND outpatient) referrals start "well known to Dr..." since that is often code for lowered interest & application by the referrer, it is absolutely true that past knowledge of a case is very valuable indeed (as are old notes, & of course is reading them!!), not just in primary care. With the limitation of 10 minutes to the GP, it is very obvious when the physician has been unable to fully acquaint themselves with the situation when it is the first time they have met the patient.
The target culture putting haste as the only measure of performance fuels this (& indeed some patients seek out the novice or locum for secondary gain). This is no different when patients come 100 miles to see me via Choose & Book, rather than see their local expert who has known them for 10 years & has full access to scans & tests without the data protection restrictions I do perhaps a week or few later. I can discharge cases I know on the same day from the EAU or the Clinic, ultimately completing the Consultant Episode more quickly & at a much lower cost.
Coalface GPs know this well of course, but the drivers at play for emergency & scheduled care make it impossible for my poor primary care colleagues, as does the time restriction they have to see an individual. Tortoises live longer than hares & accrue knowledge (about their patients).
Graham Warner
Competing interests: No competing interests