I practice in a community with relatively few subspecialists, and as such I am used to caring for most of my patient's needs. When consultation is required, I initiate it, and the consultant reports back to me, and generally makes recommendations to me about care which I then integrate into the overall management plan.
I have a couple of patients, however, who have arranged to see one or more subspecialists on their own, and who now are the poster children for fragmented care. When the patient comes to see me, they are on unidentified medications from various doctors who not only do not communicate with me, but do not communicate with each other. Literally, I do not know how to provide care for these folks. Any records I can eventually pry out of the other offices are out of date, and bereft of any overall plan for care. I feel like some forensic anthropologist trying to reconstruct a skull from bone fragments, and every time I turn my back an army of ants comes in and rearranges the fragments.
My reading of posts and magazines leads me to believe this is common rather than rare in other parts of the country. How do primary care physicians function in that environment?
