Three Suggestions for Improving the Coordination of Care Between Specialists

For several weeks, our client Melissa was becoming increasingly frustrated and concerned. Not only was she planning for major heart surgery, she was also gaining weight, having trouble breathing and feeling “tired all the time.” On top of all that, she felt that her doctors weren’t listening to her and were not even communicating well with one another.

Unfortunately, this type of frustration and confusion is not uncommon. With complicated medical issues in particular, there are necessarily many specialists and other professionals involved. It’s easy to feel lost in the mix.

With that in mind, we offered three suggestions to Melissa.

First, take a holistic view.

In speaking with Melissa, it became apparent that she was self-selecting what information to share, based on which specialist she was meeting with. During her appointment with her cardiologist, for example, she would focus only on her heart. When speaking with her kidney doctor (nephrologist), she only shared information related to her renal system.

As a result, none of these physicians had a complete, holistic view of Melissa’s condition. In her effort to “streamline” the process she was inadvertently withholding important information related to her weight gain, fatigue, and more, all of which were important to assessing her overall health.

Some of the specifics we suggested she share with all specialists:

“I can only walk 30 feet before I have to sit down”

“I’ve gained six pounds since our last visit and my ankles are puffy.”

“I can only do things for a short period of time. I’m so exhausted I can’t even enjoy my bridge game.”

Over the next month, and thanks to our coaching, Melissa realized that her job was to clearly, concisely and accurately describe what was going on with her entire body, regardless of which specialist she was meeting.

Second, use your primary care provider as your point person.

When coordinating care among a variety of specialists, a primary care provider’s perspective, medical knowledge, and long-term relationship with the patient, are invaluable. Prior to our conversations, however, Melissa was attempting to manage all of this coordination on her own.

We suggested a different approach, one in which Melissa used her primary care provider as her care coordinator and referral source — someone who could facilitate communication between her cardiologist, nephrologist, and others (physician to physician, and with all the necessary information communicated clearly).

This freed up Melissa to focus more on her health and less on playing information traffic cop!

Third, develop an agenda for all appointments.

We’ve written many times before about the importance of creating and following an agenda in medical appointments. An agenda accomplishes a number of things, particularly when accompanied by clear and specific language:

  • “Leveling the playing field” — not only does your physician have an agenda but you are conveying that you have one as well. (“I prepared this agenda so we can be sure to touch on the topics I’d like to talk about.”)
  • Conveying the key topics, priorities, issues, concerns, questions in your own words. (“I need to discuss my weight and extreme fatigue.”)
  • Allowing you to let the physician know you need him/her to view you as a “whole person” and not an organ or system. (“I know that you are a specialist, but it’s really important that you view me as a whole person.”)
  • Facilitating the communication of your expectations. (“It’s my expectation that when we leave here today we have a plan in place and we are both clear on next steps.”)
  • Confirming what specialists know about each other and their view of working as a team. (“My perception is that my specialists aren’t speaking to each other. How can we facilitate better communication?”)
  • Clarifying how information will be shared among team members. (“Would it be possible for you to call Dr. Jones and speak about my kidney issues? And then get back to me after that conversation?”)

For more specifics on creating and using an agenda effectively, see our newsletter from February, 2013.


Clear communication between yourself and your physician can sometimes be difficult, even under the best of circumstances. When one or more specialists are involved, things can become even more complicated and the opportunity for miscommunication and frustration even more acute.

As an empowered and active participant in your own health care, these three steps will help ensure that you receive the best care possible.