Chapter 46 Working with IT and the general practitioner
ED AND THE GP
The disciplines of general practice and emergency medicine may be thought of as two ends of the one spectrum of true generalist medical practice. While emergency medicine focuses on the more acute end of the spectrum, the similarities between the specialties are greater than the differences, although the differences are sufficient to mean that working effectively in one field does not predict success in working in the other.
Admission procedure
What many admitting officers do not understand is that GPs on the phone are not generally asking if a patient should be referred to the emergency department—they are telling you that there is a patient that requires review or admission. Too often questions from the emergency department’s admitting officer to the GP appear to be an attempt to prevent a referral rather than to facilitate care for the patient. Equally frustrating to an experienced GP, who is aware of the complex medical and social history of a patient, is to refer a patient to the emergency department for admission, only to have the patient assessed by a junior doctor and then sent home. The lack of value in this type of assessment has led to development of ‘third-door’ initiatives by which GPs refer patients directly to inpatient teams if their patients require admission.
Communication
Communication is particularly important when the GP has asked to be notified of the outcome of an emergency department referral. Effective communication is a prized skill of GPs and is strongly emphasised during their training, so any failure of communication (verbal or written) by the emergency department to the GP following a referral to the emergency department (or other hospital department) is an endless source of frustration. Adverse events and complaint rates can be reduced by communicating directly with the GP about the outcome of a consultation. Each emergency department should have a list of local GPs with their phone numbers. Divisions of general practice are usually very well organised and helpful: they can often provide current lists of local GPs and their hours, availability and capacity for bulk billing. (Put copies of this in the waiting room.) Some divisions offer a uniform referral form.