What do Referring Doctors Want From Orthopedic Surgeons?

So much of each orthopedic and spine surgeon’s business relies on referrals from primary care physicians—who, it should be mentioned, are overworked and may not understand how best to communicate with orthopedic and spine surgeons.

A new study from Harvard’s Brigham and Women’s Hospital studied the primary care physician and orthopedic surgeon link and uncovered fascinating insights and suggestions. Their work, “Primary Care Physician Preferences Regarding Communication from Orthopaedic Surgeons,” was published in the December 23, 2023 edition of Foot & Ankle Orthopaedics.

“My appreciation for my colleagues in primary care and their administrative burden led me to this work,” explained co-author Christopher Chiodo, M.D., section chief, Foot and Ankle Surgery Service, Brigham and Women’s Faulkner Hospital. “In addition, I saw wide variation in my department when it comes to reaching out to primary care physicians regarding shared patients. Some colleagues sent every note to the patient’s primary care physician while others sent nothing. I felt that some guidance was needed.”

The Brigham and Women’s team surveyed 107 primary care physicians, the researchers collected information on years in practice, panel size, typical number of electronic clinical messages received each day, time spent in the electronic medical record (EMR) after normal clinical hours, and burnout level.

The team found that PCPs were most likely to rate communication from orthopedists as highly important when the orthopedist needed information from the primary care physician. In these instances, primary care physicians preferred to receive an Epic Staff Message. Primary care physicians also told researchers that the following scenarios were important:

• the decision for surgery,
• hospitalization, and
• a major clinical change.

In these scenarios, a cc’d Chart rather than Staff Message was preferred.

Increased EMR use after-hours was associated with diminished odds of having high interest in communication from orthopedists. Furthermore,

• Ninety-three primary care physicians (86.9%) reported spending at least one hour a day in Epic after clinical hours.
• Twenty-seven (25.2%) spent more than three hours.
• Forty-six PCPs (42.9%) reported experiencing at least one symptom of burnout.

“Several primary physicians have noted that the cc’d chart section of their in-basket has many more items when compared to the Staff Message section,” Dr. Chiodo explained to OTW. “In addition, some have commented that cc’d chart messages are considered more of an ‘FYI’. Staff Messages, however, is more akin to ‘you need to know this’ or ‘your attention is needed here.’”

“I think the takeaway is that, unless you need the primary care physician to take action in some way, the information can be sent as a cc’d chart. I wouldn’t say that primary care physicians prefer cc’d charts in critical situations, so much as that unless you need something from them, they prefer the message be sent as a ‘lower priority’ cc’d chart.”

“Of course, they care if their patient is in a critical situation and do want to know. However, my interpretation is that they want to streamline what goes into the more ‘high priority’ inbox and with this streamline and prioritize workflow.”

When OTW asked what remains unclear about communication between orthopedic surgeons and primary care physicians, Dr. Chiodo stated, “How to identify and possibly log the preferences of individual primary care physicians remains unclear. With this information, you could more fully customize communications at the institutional level. Perhaps artificial intelligence could play a role here.”