Talking to A Doctor

How do you share information about patients across doctors? Across
functions? (i.e. nurses, types of doctors, billing dept., etc.)
o Privacy rules that forbid sharing information with an outside provider
o In a hospital, I can share any info. with someone in the hospital as long
as it’s related to the care.
o I can’t share information just to share
o If I am a general doctor, I put in a consult request on the computer. Or
I could call them. When the cardiologist starts his day, he will get a
request in his in box. These are patients being seen within the
hospital – admitted.
o General computer system that we have in the hospital: any patient
who is seen ever in MUSC has a medical record number that follows
them. When we type in that number for that patient, we have every
piece of information about them – who are their doctor, what has
happened to them; any doctors affiliated with MUSC doctors in the
hospital and outside of the hospital. If they aren’t seen at MUSC, then
we need to go fishing for information with signing release form – that
gets complicated.

How do you make time to learn shared information? Share the
information you have learned? How much time do these activities take?
o After I am done seeing a patient, they write a not on what happened
during the time that they have seen a patient. You can’t bill for seeing
a patient unless you have a note about what happened.
o In any situation, I am going to write a note saying what happened in
that situation. We have medical lingo – a format that we use to
communicate that information. A standard format.
o These are typed into the system.
o There are hospitals that are not totally online – doctors write things
by hand. Still, when these patients are released, they do a summary
that is electronic.
o Most hospitals are moving toward electronics. Paper is more
complicated. The computer system is a complex computer system –
captures all lab reports, medications, allergies, many different
sections including medical notes – you can even filter these. New
providers get tech orientations.
o Take you through a day
 Patient has heart failure. They have a primary team of
physicians that are responsible for their care. These doctors
review their care every morning. We do check out with the
person who was there before – getting information from the
person who was with them before. Then, we get information



directly from the patient, if that is possible. We also do a
physical exam – this is all learning.
After we examine the patient, we make decisions. Based on
what we have learned, we are going to make decisions. We
make a plan for this patient. We come up with a list of things
that need to be done for this patient, including health and
social services. All of the things that need to happen for that
patient – can be a single or multiple day plan.
The learning is constant. If we are having a difficult time
putting together what the patient is dealing with, we go to the
literature to look for information about what may be
happening. We are constantly refreshing our base knowledge
as we go. This happens during the work day.
We are also at a teaching hospital. We have medical students
and residents that do most of that grunt work and will present
that information to the head doc.

What works well about information sharing? What could be improved?

What types of team meetings do doctors participate in? What are the
goals of these meetings?
o We have team rounds. After the morning rounds, we come together,
divvy up responsibilities and talk about our day. There is no rule as to
when there is patient information sharing time. Everyone does this
differently.
o We go patient by patient, discuss what is going on with the patient.
The doctor may know what is going on. Our mission is education at
MUSC – medical student and resident education is almost as
important as patient care.
o This meeting helps to inform your plan for the patients. It also helps
to determine who us going to do what in the plan.

How often do team meetings take place?

What works well about team meetings? What could be improved?

How do doctors continue to learn once they are practicing? How are
these learning opportunities structured?

Are their things that work well regarding continued learning? What
could be improved?