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PRESIDENT’S
MESSAGE

EFFECTIVE COMMUNICATION BETWEEN PATIENTS

AND PHYSICIANS IS ESSENTIAL TODAY

By Sheldon Gross, MD, 2018 BCMS President

Dear Colleagues,

For this month’s issue of San Antonio Medicine, gious medicine. We spend so much time as physicians learning how to effec-
I would like to discuss the importance of physi- tively communicate with our patients. After 35 years of private practice, I am
cian communication in medicine. This is one of still learning how to effectively communicate with my patients. I would like
those statements that sounds obvious. One does to ask how much time do physicians spend learning how to effectively com-
not require an M.D. to understand the importance municate with other physicians? The answer is amazingly little time, and I
of physicians effectively communicating with think this could be at times as important or even more important than com-
each other. municating with individual patients. It seems that part of a physician’s formal
As medical students, most of us were taught rules regarding when not to training should include how to communicate with other doctors. When is a
communicate. Certainly, one does not discuss relevant patient information note in the chart adequate and when is a telephone call required? None of
on an elevator when others cannot help but listen to what is being said. Physi- us like to be interrupted by telephone calls while we are seeing patients or
cian discussions have to occur privately and in settings in which patient con- otherwise involved in our practice. However, when a secretary states that Dr.
fidentiality can be protected. We have all learned that it is crucial to know Smith is on the phone and it is an emergency, all of us should be willing to
who we are allowed to communicate with. This is especially true in pediatrics. drop what we are doing and speak with Dr. Smith. Our patients depend on
Communicating a patient’s personal health information to someone who does us and assume that we will communicate effectively with the appropriate
not have legal custody or legal permission can be not only inappropriate but physicians involved. That is as much a part of our responsibility as prescribing
possibly illegal. Physicians can be placed in a very precarious medical legal the correct dosage of any drug or ordering the appropriate imaging study.
position if they release information to the wrong person. This means communicating with physicians that we like and work with rou-
Having discussed who not to communicate with, it is probably more im- tinely. It also means communicating with physicians that we may not know
portant to discuss how physicians need to communicate. I am familiar with or possibly even dislike with the same degree of responsibility and urgency.
multiple malpractice lawsuits that could have all been avoided by either physi- There have been books, studies, and models of healthcare tried for years in
cians communicating with each other more effectively or communicating an attempt to save money and have more efficient and quality healthcare.
with the patient or the patient’s family. We now have access to text messaging, Something very basic has been overlooked. I have no doubt that enhanced
emails, and any number of other means of communicating electronically. I physician communication would provide better and less expensive care with-
would suggest that in certain instances, none of this takes the place of a out the need for new technology or new models of healthcare. In my case as
phone call and person to person discussions. In my practice, I have made a a child neurologist, it is not unusual for one of my patients to arrive in an
point as a consultant to personally contact by telephone a referring doctor if outlying emergency room with breakthrough seizures. Many of these patients
there is a major development with one of their patients. Should an MRI scan will be immediately sent for imaging studies. These patients may have already
reveal a brain tumor or should someone require hospitalization, I do not rely had multiple imaging studies in the past which have all been normal. A phone
on text messaging or having my secretary call their secretary. I have also found call to my office would clarify that and obviate the need for many expensive
that when referring doctors receive this type of direct phone call from me procedures. I am sure that this is true in every specialty.
they are not irritated by an interruption in their busy schedule. In fact, they I would invite any reader who knows of a specific example of how en-
are typically very grateful that I would take the time to call them and notify hanced physician communication can improve healthcare and lessen cost to
them of serious developments. I am very concerned that too many physicians, please put that in writing and send it to the Bexar County Medical Society. A
particularly younger physicians, feel that a text message or email is the equiv- telephone call depends on technology that has been around for many years.
alent of a live discussion between two people on the telephone or in person. I would stress the importance of physicians trying to develop ways of in-
It is not the same. I do not always have my cellphone with me. There is some- creasing healthcare efficiency. If we abdicate that responsibility, it is inevitable
times a delay in checking my emails. Despite how far we have come from a that health plans and insurance companies will only take more draconian roles
technology standpoint, live discussion is still the gold standard. in making decisions for us.
Regretfully, getting someone on the telephone is not as easy as it used to As always, I welcome any response from those who agree or disagree with
be. We are typically met with telephone recordings with a various menu of my comments. I wish to welcome those physicians new to San Antonio,
different options. I have had the unpleasant experience of being forced to whether in training or in practice. Bexar County Medical Society would like
leave a message on a recording when I desperately needed to speak with a to invite you to become active participants and offer any suggestions to en-
physician at that moment. I would state that it is the responsibility of all physi- hance our relevance to membership.
cians to be certain that they can be reached by other physicians in emergency
situations. It is a physician’s responsibility to ensure that another physician is Sincerely,
not required to leave a message on a recording or have his secretary contact SHELDON GROSS, MD
someone else’s secretary. This is not only bad medicine but is potentially liti- President, Bexar County Medical Society

8 San Antonio Medicine • September 2018