Flea has a great post about specialists not giving credit to primary care docs for staring the work-up and, often, making the diagnosis before the specialist even sees the patient:
In his letter, however, the gastroenterologist failed to mention any of the work-up that I had performed, and stated matter-of-factly that he had made the diagnosis.I respond in his comments, but I'd like to lodge a complaint from the other side of this interaction. Specifically, any workup you do is of no use to me if I can't get hold of it.
In a collegial manner, I offered that at best the diagnosis was a joint effort.
My colleague's reply was "My goodness, I didn't think you guys (i.e., you fleas) actually read these letters!"
Again and again I see a patient referred for "immunodeficiency." Like many kids, the patient has been on antibiotics a lot. The primary (PMD) has sent some lab tests and apparently they were abnormal. I say "apparently" because I don't have them. The parents assumed the PMD's office would send or fax them but they didn't. Our nurses are happy to call, but don't appreciate being on hold for 15 minutes, then being told the office is too busy to fax it over right away. At times I have to personally call the doctor to plead with him to have someone fax them right away. Meanwhile, the family sits for an hour while we wait for the results of these tests. Usually, the tests are fine (one lab locally doesn't correct the "normal" immunoglobulin range for age, so all kids come back artefactually low), and I can reassure the patients, but it would sure be helpful if I had those tests right away.
So, primaries, think about using your consultants wisely. Everyone benefits when the workup you've done is available to the consultant: it makes my life easier, I can communicate what I think to the patient and parents in person not in a phone call later, and unnecesary and duplicate testing is avoided.
UPDATE: added link to Fleas and his original post which I swore I'd already put in.