One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider.  This can take many forms--- a phone call, texting via smart phone, email, messages sent via EMR, and dictated letters.  The format is pretty standard no matter what medium is chosen.  You thank the referring doc for the consult request, you give some brief background info about the patient in question, and then you articulate an assessment and plan.  Then you thank the doc again.  Multiple times if necessary.  Because your livelihood depends on whether or not that doctor decides to continue to send patients your way.  

My practice is to freely text physicians I know well about their patients.  It's instantaneous, it's informal, it breeds a certain collegial connectivity that is good for business.  I also like free-form written emails via our internal encrypted system.  In addition, our outpatient EMR auto-creates "referral letters" to primary doctors.  These get sent to the doctor's inbox as soon as I click "sign" on my office notes.  These notes are really something.  Not exactly an unearthed archive of F Scott Fitzgerald corresponding with Hemingway, these babies.  Some computer algorithm takes your office note, chops it up into relevant blocks of transferable data and information, splices in seemingly human-sounding phrases and sentences, and then synthesizes it all back together to make it look like an actual letter.  I sometimes try to type in a block of text toward the end in an attempt to personalize things but that usually just gets buried under an avalanche of x ray reports, review of system minutiae, exam findings, and various instances of tortured computer-generated syntax.

Prior to EMR and texting and instantaneous communication, most specialists had no other option but to dictate referral letters to their feeders.  And for some reason it evolved that the referral letter had to be composed in this faux-formalized, knock-off Henry Jamesian diction and syntax, as if American doctors were a bunch of 18th century courtiers.  

The construction of her sentences leads one to believe that "quotidian" mistakes, like BEDSORES, are the biggest killers.  This should strike an average healthcare professional as ridiculously absurd.  Bedsores demonstrably are not striking down thousands of patients every year, like an army of ghastly demons leeching onto unsuspecting patients' sacrums and heels and ischial tuberosities.  And Ms Kliff seems to know this as well, as betrayed by this line:

So yeah.  Bedsores are found in frail, elderly, non-ambulatory, demented patients who present to hospitals with a host of medical problems.  Many of them die.  Many of them have incidental bedsores.  Correlation is not causation, of course.  Ms Kliff acknowledges this.  And her unnamed "experts" sure are getting a lot of mileage out of the phrase "almost certainly" when asked to provide evidence of an association.   This is obscurantism is its finest form.


After the bed sore non-sequitor, Kliff makes some valid points about physician transparency and the difficulty of identifying errors when they occur.  She also assails the "fee for service" model as a source for disincentivization to correct mistakes and prevent them from happening again.   Finally she assures her readers that this post is the first in a year long series investigating fatal medical errors.  She then affixes a form for readers to fill out if they or their loved ones have been the victim of a medical error.  This form asks "Type of Harm" (and the participant is to check all that apply).  Choices include: "Infection", "Surgical Injury", "Bedsores", "Fall", "Medication error", "Blood Clot", "Device (ortho or cardiac).  

Ms Kliff has committed a very common error here, creating a false equivalence between the concept of known complications related to procedures or disease processes and true negligence/malpractice.  Surgical injury, of course, is my personal favorite listing.  I love the use of the pejorative  word "injury" rather than "complication" or "unexpected outcome".  So now surgical site infections, post op pneumonia, hernia recurrences, duct of Luschka leaks, anastomotic dehiscences, and other surgical complications are re-defined as "injuries" suffered as a result of "medical errors".  Certainly many bad surgical outcomes are the result of incompetence or negligence.  Most are not.  Most are simply known complications of a well described procedure.  Mixing up the two is tantamount to journalistic malpractice.   

It will be interesting to read Ms Kliff's follow up articles on this important topic.....