Understandably, authors of medical studies prefer to cast their findings in strong, unambiguous terms rather than admit that their results probably can be interpreted any number of ways and that the interpretation they preferred had a good shot at generating media buzz, or it best fit their hypothesis, or some other possibility. Where researchers stand depends, as the expression goes, on where they sit. A recently published online paper in the Journal of General Internal Medicine, based on a phone survey of several thousand individuals who had a regular primary-care physician and visited at least one specialist in the previous year, offers an example.
The finding highlighted by the authors was that "less than half" of the responding patients—46 percent—said their primary-care doctors "always seemed informed and up to date" about the care the specialists had provided. Overall, that is, coordination and information flow between primary-care providers and specialists, as reported by patients, was "less than ideal."
I saw the results differently. "Always" is a far-fetched standard to apply to anybody, let alone a primary-care physician trapped in a system that punishes her if she spends too much time with patients. Moreover, the choice after "always" was "usually—almost always," which 31 percent of the respondents chose. So if the survey was representative, 77 percent—more than three fourths—of primary-care doctors usually, almost always, or always were on top of the care that their patients were receiving from specialists.
"Less than ideal"? There are good reasons internists, family practitioners, pediatricians, and other doctors at the front lines are dropping out and medical students are choosing to specialize. If most primary-care providers are still following up, still discussing specialist visits with their patients, I think that's pretty remarkable.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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