Uncoordinated Care

A patient got pregnant while taking a drug I prescribe, but stopping the drug could arguably pose just as much risk to both fetus and mom as continuing it. The patient wants me to coordinate with her OB. I want to coordinate with the OB.

The OB’s office leaves a voicemail message asking me to provide my fax number. I call back. Can you hold? Sure. After five minutes on hold I ask what they want to fax to me.

“I don’t know.”

Minutes later I receive a poorly written authorization for release of records, signed by the patient. Problem: I am a psychiatrist. No one has checked the box indicating specific consent for psychiatric records.

It gets worse.

“Reason for this authorization...”

Checked: “__ at my request”

I never would have guessed.

“This authorization does not permit disclosure of health information created more than:”

Checked: “__ in 90 days from the date signed”

Does the OB really expect me to review the record to remove all entries older than 90 days? In her dreams! She gets all or nothing. (Never mind the poor grammar.)

I look back at the top:
“You may use or disclose the following healthcare information...”

“__ All healthcare information in my medical record.”

Which is it? All, or just the past 90 days?

I ask the patient to sign my own authorization form. She agrees.

But problems remain. I still do not know whether the OB just wants records, or wants to talk to me (my preference). If she does want to talk, how many times must I wait on hold just to arrange this with a receptionist?

Part of me also wants to help this colleague get her procedures right, but somehow I doubt she cares what I can offer.

My theory: This impediment to coordination of care results directly from acronym soup: EMR (and what many call meaningless use), ICD, CPT, HIPAA, CMS, CFR, all sucking precious physician time and energy away from patient care.

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