Howard County General leaders address communication issues between primary, hospital doctors

State Del. Terri Hill hosted an open panel with Howard County General Hospital leaders Tuesday at Kahler Hall in Columbia to ease concerns about possible restricted communication between primary care doctors and hospital-based doctors, known as hospitalists.

Hill said residents have shared their concerns with her over the past four months, noting that they don’t want their personal doctors left out of medical conversations if and when the residents are admitted to the hospital.

On Nov. 27, hospital officials, alongside Hill, assured the crowd of about 100 people that Howard County General hospitalists will stay in contact with primary care doctors and are there to provide immediate care when community physicians are inaccessible.

Hospitalists were introduced to Howard County General to work overnight hours, Hill said, when most primary care physicians were typically unavailable. Patients’ primary care doctors were then alerted of their patients’ hospital admission the following morning to continue care.

The program was originally optional to patients, said hospital president Steven Snelgrove, but became mandatory as patients, particularly seniors, needed emergency care during off-hours.

In August, Andy Lazris, a primary care physician in Columbia, sent Hill a letter about how the hospitalist program negatively impacted his 92-year-old patient, who he referred to as Mr. G.

Lazris said in the letter that Mr. G received “a series of unnecessary tests” after hospitalist doctors found what they believed to be other problems during a urinary infection diagnosis. Lazris said he was not contacted during Mr. G’s stay at the hospital and that his patient was “far worse” afterward.

In response, Hill, who represents District 12 and is also a physician at Howard County General, set up Tuesday’s community forum to connect hospital leaders with her constituents.

“There are some physicians in the community who find this a comfortable arrangement and it takes a little bit of a burden off them,” Hill said. “But there are some community physicians, particularly the ones with the concierge practices, who feel they’ve built their practice on that very personalized care.”

A lack of communication between community physicians and hospitalists has led to unnecessary confrontations and sometimes tests, she said, which is not only inconvenient for patients, but also raises costs of healthcare.

Snelgrove, cardiologist and Department of Medicine chairman Michael Silverman and hospitalist Melinda Kantsiper agreed that communication is necessary between primary care physicians and hospitalists. During Tuesday’s program, Snelgrove said the hospitalist program is designed to keep patients safe and healthy around the clock.

“We would love to be able to communicate with physicians any time [patients] come into our hospital, but there are many times that [their] primary care physician is not available at 3 o’clock in the morning for that phone call,” he said. “We find that somebody who handles a 45-year-old healthy person, who comes in with a broken arm, doesn’t want a phone call at 2 o’clock in the morning. The problems with frail elderly people are typically complex.”

A policy dictating “one way to do everything” wouldn’t work in the hospital, he said, but that doesn’t mean primary care physicians shouldn’t be informed of their patients’ hospital care.

Kantsiper, the director of collaborative inpatient medical services at Howard County General, said her staff talks with primary care doctors every day and shares patient records.

Primary care doctors receive lists of their patients who are in the hospital, she added, and hospitalists are board certified.

“Many of those doctors will take a look at those lists and if it looks like it’s pretty straight forward, they may or may not reach out to us,” Kantsiper said.

Nancy Pilotte, a 30-year Columbia resident, said she worries about patients who may fall through the cracks due to little communication with primary care doctors. When Kantsiper said she feels better having patients with families or friends to share crucial medical information, Pilotte said families “are not always heard.”

“It’s something we’re really worried about and work on every day,” Kantsiper said. “Even getting the most accurate medication list for a patient is hugely challenging. I know outpatient and inpatient doctors are committed to trying to make it better.”

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