Referral or follow-up?
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7524.1072 (Published 03 November 2005) Cite this as: BMJ 2005;331:1072
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I was disappointed that Frank Sullivan and Jeremy Wyatt suggested
that the "collusion of anonymity" occurs when hospital and primary care
each thinks the other is arranging follow up. I don't think this is
correct.
The phrase was coined, as far as I know, by Michael Balint and and
the collusion truly occurs when "the patient is passed from one specialist
to another with nobody taking responsibility for the whole person"
(Editorial: The Doctor, his Patient and the Illness - revisited. Balint
Society Journal; 2005. 33http://www.balint.co.uk/journal).
This is an important issue which I think is fundamental to good
medical practice and crops up daily.
Competing interests:
None declared
Competing interests: No competing interests
This is the era of information superhighway and globalization. It is
high time that we incorporated information and communication technology to
the health care sector. Electronic continuity of care between different
parts of the health system will not only ease the work load of the health
care provider but will also deliver an advanced up to date service to the
community.
Some government hospitals and most of the private hospitals in Sri
Lanka have already started integrating clinical records from different
parts of the island. So it is a tangible obstacle and once implemented it
is sure to hit the hearts of the health care providers and the patients.
Competing interests:
None declared
Competing interests: No competing interests
Individual Responsibility vs. Collusion of anonymity
Sullivan and Wyatt present a comprehensive and thoughtful piece on
the eternal question of 'who is responsible' ?
I am sure Wilfrid Treasure recalls his Balint correctly - that the
collusion truly occurs when "the patient is passed from one specialist to
another with nobody taking responsibility for the whole person". In the
50's and 60's it was a call to General Practice to shoulder a specific
mission.. But doesn't it now sound terribly dated.. implying a time when
doctors were responsible, but not patients ?
Today, unless the patient is incompetent, "reponsiblity for the whole
person" belongs firmly with that individual self !
GPs are well-advised to shoulder their own personal responsibility
for their actions, but not attempt to usurp the patient's
responsibilities.. Sullivan and Wyatt give much thought to models and
mechanisms which may help both hospital and GP to meet their
responsibility (including good IT and communications) - but it should be
remembered that the patients remain responsible for themselves..
Competing interests:
None declared
Competing interests: No competing interests