Continuity-of-care struggle

As a primary care physician, I thoroughly enjoyed the generalist vs specialist dichotomy that was presented in "Whose patient is it?" [Feb. 16]. I commonly observe a lack of collaboration in terms of communication between these providers. I hear specialists lament when a patient arrives at their office without paperwork containing previous workup and testing by the primary physician. Conversely, the PCP may never receive any consultation notes from the specialist.

In this age of information technology, I believe that communication can be easily facilitated by means of e-mail, electronic medical records, or a simple telephone call. Improved communication builds trust, nurtures professional relationships, and makes it less likely that patients will bounce back and forth between primary care physicians and specialists.

It is critical that providers work cohesively in this era of spiraling healthcare costs, yet relatively poor healthcare outcomes.

Hien Nguyen, MD
Fairfax, VA

Another question to consider in regard to Senior Editor Ken Terry's "Whose patient is it?" is "Whose fault is it?"

Except for the "self-referred" patient, one solution would be to use a well-constructed referral form such as the "Request for consultation" found in "When you refer the patient" ["Clip and Copy," Oct. 7, 2005], published in conjunction with "If the patient needs a consult."

This type of form provides specific guidance to the specialist as to what is expected. If the guidelines are not respected, it may be time to choose another specialist.

Requesting a consultation for a patient with a complex diagnostic or therapeutic problem is always a wise choice. But both the referring and receiving physician should understand their respective roles, and their functions should be made clear to the patient as well. Utilizing a detailed request for consultation form can clearly delineate these roles.

John J. Deller, MD
Palm Desert, CA

Our healthcare system is the real problem. It's driving a deeper wedge between primary care physicians and specialists. When costs go up, Medicare cuts fees across-the-board. Specialists respond by performing more procedures, but PCPs can't do anything but see more patients in less time.

The divergence between primary care and specialists' income is increasing, and it's troubling to see some physicians react by doing things beyond their scope of training.

Kumud Jindal, MD
Yonkers, NY

Doctors in a tough spot

Compliance. An interesting word. Consider what it means: To act in accordance with someone's rules, commands or wishes ["Compliance: What about a crackdown on patients?" Mar. 2]. I view my patients as free souls who make their own choices in life. I have no right to demand that they "comply" with my or anyone else's notion of how they should eat, smoke, recreate, or procreate. Nor am I responsible for the consequences of their actions. I give them advice and offer them treatments. They are free to accept or reject my services, and they owe me no explanations.

As a society, we can walk in the light of freedom, respecting each other's right to live life as each sees fit, or choose to regard individuals as subservient to society, forced to comply with its demands (which are generally concocted by a small, mostly self-appointed elite).

As for me, I prefer to live in freedom and I respect my patients' right to do the same.

R. Wayne Porter, MD
Terrell, TX