Gastroenterologists & Primary Care Physicians: How to Build Meaningful Relationships

Two gastroenterologists discuss building relationships with primary care physicians to boost referrals and create a continuum of patient care.

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: How can gastroenterologists become business leaders in their field?  

Please submit responses to Carrie Pallardy at by Thursday, May 8, at 5 p.m. CST.

Dr. James LeeJames Lee MD, AGAF, St. Joseph Hospital, Orange, Calif.: Accountable care organizations mandate to deliver most efficient care in a timely manner has put more incentive for a closer collaboration between primary care physicians and gastroenterologists. It would be in the interest of both parties to work seamlessly in providing care. Building a close relationship with primary care physician is important for ensuring steady referrals and necessary for the best patient care.

In order to increase referrals from the primary care physicians, it would be important to examine what primary care physician consider in choosing a specialist. In a recent study (Ann Fam Med, May 2004), four of the most important factors in choosing a specialist were as follows:

•    Medical skills of the specialist
•    Previous experience with the specialist
•    Appointment timeliness
•    Quality of communication

Since the practice of primary care is rapidly changing and expanding with new medical knowledge and information, gastroenterologists can greatly aid the primary care physicians to provide the best patient care in a cost effective manner. One way is to share new information and clinical guidelines with a primary care team. This sharing of information can be accomplished through community lectures, grand rounds, distribution of printed materials as well as providing clear communications in consult notes for shared patients. For example, recent development of the new technology called radio frequency ablation of Barrett's epithelium to prevent cancer changed the management of Barrett's esophagus with dysplasia. By sharing and disseminating new clinical information gastroenterologist can consolidate relationship with primary care physicians, which can lead to an increase in referrals.

Another way for gastroenterologists to aid primary care physicians is to improve access and communication. For a patient to be referred in a timely manner, a well-defined scheduling and screening process needs to be in place between primary care physicians and specialists. This may involve a reviewer for referrals or automated sites such as eReferrals and eConsults, which have been utilized with great success in some states. The latter may involve patients' willingness to accept that they may not see the specialist in person. One way to accommodate urgent patients is to set aside time slot for urgent referrals only. This will prevent overbooking and provide more efficient care. The increasing utilization of electronic health records by physicians should also improve communication between the primary care physicians and specialists since data sharing is readily accessible and available.

The relationship between gastroenterologists and primary care physicians will evolve with the advent of the ACA and EHR and may rest on the public as well as physician's willingness to accept changes and adapt to a new medical landscape.
Patrick TakahashiPatrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center, Los Angeles: Gastroenterologists can continue to build relationships with primary care physicians in a multitude of ways. I believe that communication is paramount to the success of any such symbiotic relationship. Trying hard to send referral reports, procedure reports, as well as biopsy reports in a timely way is a great way to garner the trust of a referring physician.

My own electronic health record allows me to send such reports with a single click, obviating the need or possible mistake of office staff forgetting to do the same. Referring physicians want gastroenterologists to communicate with them regarding their patients in a non-obtrusive way.  The EHR can help with this venture. Often times, an EHR will allow physician-to-physician communication, which is very helpful as collaboration can take place quickly via this manner, without having to exit the EHR itself for separate emails, faxes and the like. Of course, the three "A's" are critical for success, that being ability, affability and availability, not necessarily in that order!

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