I know, I know; I should consider myself lucky just to get letters from specialists when I refer patients to them without being so picky about what those letters actually say. Still, it's the little omissions in their letters that add up to the persistent, niggling disrespect for family medicine that really pisses me off.
I saw an older lady who stepped into a hole (covered with grass; it wasn't her fault), fell about two feet straight down, and hurt her ankle. I asked her to come into the office where I took a history and examined her. Based on my evaluation, I diagnosed a fracture of the distal fibula and sent her for confirmatory x-rays. As it happens, my patient demographic expects an automatic orthopedic referral for any and all fractures, so the positive x-ray prompted the referral.
Today I got the letter about her visit.
In it, the orthopedist duly repeats the history he obtained from the patient. (I suppose I should consider myself particularly lucky in that it was the same as the history I obtained) followed by this line:
She called her PCP, who ordered x-rays and referred her here.[Great gnashing of saurian jaws]
Wait one dang-blasted minute! Talk about omitting pertinent details!! In order to be accurate, that note should have read
She called her PCP, who saw her in the office, examined her, diagnosed a distal fibular fracture and ordered confirmatory x-rays, and referred her here.Remember, if it isn't documented, it wasn't done. So as far as anyone in this orthopedic office is concerned, they were the ones who diagnosed the fracture. I'm sure there are those who will accuse me of making a mountain out of a molehill, but I don't think so. These little slights may seem insignificant in and of themselves, but over time they result in a gradual wearing away of the esteem in which family medicine is held by other doctors.
And that pisses me off.