Garth Rattray | Patient care is a team effort

On January 25, the Medical Council of Jamaica hosted their Annual Ethics and Mental Health Webinar. The speakers were Ethicist Dr. Shereen Cox, professor of pharmacology and pharmacovigilance Professor Maxine Gossell-Williams, Psychiatrists Dr. Earl Wright and Dr. Winston De La Haye. Ethics and mental health are fairly recent mandatory requirements for the granting of annual practising certificates for physicians.

All the presenters were excellent, and the webinar was very informative and revealing. A part of what was said by Dr. Cox during the first topic, “Bridging the communication gap: Prescribing as a moral mandate not just a clinical and legal requirement”, got my attention. Essentially, she said that, in the interest of good patient care, prescribing physicians should be collaborating freely with pharmacists. I totally agree.

In my own practice, I have no compunction about communicating with pharmacists if I can’t recall the name of a drug, the availability of a drug, drug dosage, the safety profile, and/or the side effects of a medication. And, on the flip side, I welcome all communication from pharmacists because sometimes my handwriting deteriorates into an illegible scribble, I inadvertently leave off information, or on the extremely rare occasion that I make a dosing error.

I depend heavily on pharmacists as part of [what I view as] the teamwork necessary to adequately take care of patients. I do not consider myself more important than anyone else on the team. And by the team, in my setting I am referring to other physicians (including consultant physicians), nurses, clinics, hospitals, pharmacists, physical therapists, investigation facilities, caregivers, family members, and the health insurance industry.

Despite my years of lamentations, there is still varying resistance from some quarters when it comes to being team members. The most serious and frustrating problems occur when patients have been discharged (sent home) from the hospital. The patient (or relatives) should be provided with a brief discharge summary outlining the event(s) that necessitated the admission, the diagnosis, the findings, the treatment, and the intended follow-up. Sadly, it is only on very rare occasions and only from The University Hospital of the West Indies (UHWI) that we occasionally get discharge summaries.

Nobody is asking for the Magna Carta, a simple summary will do. I am tired of having to ask patients what the doctors told them. I am also tired of asking to see the medications on which they were sent home and inferring the diagnosis. I am tired of asking the patients or relatives to get a copy of the results of the various investigations done on them while they were under the care of the relevant institution. This problem occurs with public, semi-private, and private hospitals.

Although the Data Protection Act stipulates, among many things, that all information on a patient belongs to the patient, there is significant resistance to supplying that information from the public hospitals. In order for the patient (or his/her proxy) to get copies of the results (that belong to them), they are required to go through the records office at the UHWI. That system works, however, the public hospitals route requests for copies of results (no matter how urgently needed) through the ‘administration’. That department is inundated with stumbling blocks and littered with red tape. Often, in order to save the patient’s life, we have to repeat the investigations.

Another issue is the fact that primary care physicians (family doctors, general practitioners) are not allowed easy access to their patients or to the attending physicians once they are admitted into the hospital. We often have vital information regarding the patients … especially those that we have been seeing for decades. This vexing issue has been so persistent that I (for one) have abandoned attempting to visit patients in ‘public’ hospitals, or to communicate with their attending physicians.

Family doctors are subject to the same [security] rules and regulations as the regular members of the public when attempting to get through hospital gates. Security guards tell us that our medical IDs “nuh mean nutt’n” (are useless) here. The security guards are only following orders. Obviously, doctors are not a security threat. They should be allowed on the compound of any hospital, and through any gate, at any time. Whether they can interact with the patient or the attending physician should be up to the nurses on the relevant wards. They are the ones that run the wards and seeing a patient is always at their convenience and with their permission.

A long-time patient of mine was literally dying in the Kingston Public Hospital. Her relatives asked me to visit with her before the end. The security guards respectfully explained that I needed a pass to get inside to see my patient and/or her hospital doctor(s), but there was a huge crowd waiting. When asked to assist me, a uniformed nurse passing by simply said, “join the line”. She wasn’t a team player. I left, never to return.

Patients deserve the seamless sharing of information regarding their welfare. There needs to be no obstacles or barriers to communication. I thank God for the occasions when we are kept abreast or brought up to speed. However, most of the time we are left in the dark. This omission seriously compromises patient care. The lack of discharge summaries, the absence of reported findings for investigations, and the deficiency of feedback from our colleagues is disheartening, discouraging, and dangerous.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com