Continuity of care from my perspective involves the primary
care physician, not an assistant but the physician himself. Know thy patient.
Communicate with the patient. Return phone calls promptly. Be available.
As a primary care physician, secure in advance an
understanding with your specialty consultants: that when you refer a patient, you
will have access to and remain involved in the care, that as the primary, you
will read and write notes on the hospital chart, (Somebody has to read the
nurses notes) that you will receive written consultations and summaries of care
in a timely way, that you must approve of any secondary referrals, that your
patient be charged fairly according to his or her means, that you will assist
but not interfere with the specialist’s care. (This entails making hospital
rounds, often without pay, but in the long run it pays off)
Specialists, especially the best ones, welcome these
assertions as a refreshing breath of old fashion medical ethics. They will
welcome the agreed-upon source of referrals and consultations. Surgeons
especially will recognize a reduced liability from your presence and from the
added continuity of care your presence brings. They will treat you and your
patients with deference. Although they will most likely refer you patients, do
not make that a stipulation.
These guidelines of professional ethics once dominated and
still play within organized medicine at the county level.
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