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Growing the Collaborative Network...the "Old-Fashioned" Way (Well, OK, Not by Telegraph...)

Posted By Julia B. Sayre, MS, LMFT, Tuesday, March 20, 2012

I've just placed a call to a family practitioner, and faxed the release. I notice I'm feeling expectation, curiosity and a strange sense of girding for possible disappointment. I've never worked with this doctor or this practice before. Though rare, there is the occasional practitioner who just does not call back. Collaboration still, at times, feels like a bandwagon for which I'm extending invitations.

Success! The physician a) calls back within about an hour and b) I am able to answer the phone! I briefly summarize how I know our mutual client/patient (Pient? Clatient?), ask for confirmation of the medication dosage and both ask for and impart information regarding reactions to the medication. I am able to report that, based on a recent session with the patient's spouse, the medication's presumed effects garnered a glowing report: she feels better, as reflected in her reports to and interactions with her spouse. The doctor notes this, and comments that the patient never returned for a medication follow-up appointment. Note to self: This doctor does ask patients for follow-ups – my kind of practitioner! I offer to address the need for a follow-up visit to the doctor with our client when she and her spouse come to see me next week. I also ask about a medical condition the client reported – known to have a side effect of depression – and am able to update the doctor about how the client is doing relative to those symptoms: Data for the doctor.

"That went well!” I'm thinking, and then, since I'm sharing this experience, "How so?” It reduces to two major factors: the richness afforded by telephone communication combined with the availability – and good scheduling luck – that enabled prompt exchange of information.

Julia B Sayre

We could conspire to bring me into the 21st century – EXCEPT: there is a difference in communication substance when we write to our medical colleagues compared to speaking with each other. I could email questions and updates. That's fairly straightforward, but lacks the richness of data that occurs when two people converse.

 Phone calls and phone tag or email, oh my!

No question, email could expedite contact with physicians; I know, and I confess: I don't trust that I have what I need to protect client identity, and this keeps me from transmitting via the internet. I am expecting a chorus of suggestions on this (honest, I can't see you rolling your eyes) and welcome every single one, thanking you in advance. We could conspire to bring me into the 21st century – EXCEPT: there is a difference in communication substance when we write to our medical colleagues compared to speaking with each other. I could email questions and updates. That's fairly straightforward, but lacks the richness of data that occurs when two people converse.

I recently checked in with a doctor regarding a new, elderly client of mine about whom I have concerns regarding cognitive functioning. The doctor reported updating three prescriptions in her first appointment, all psychoactive, which our mutual client had just reported to me she was no longer taking, though they had been prescribed for 90 days only three weeks ago. In exactly two minutes, the doctor and I clearly understood each other. Though she had observed her patient as alert the day of her physical exam, she volunteered to do some cognitive screening and carefully inquire about medications at the follow up her patient had not yet scheduled – but that I would encourage the client to seek: A multidisciplinary dance enhancing client care. That is what I hope for: the richer data, that feedback that happens when, as participants in collaborative care, we are able to discuss factors impacting emotions, illness or medication.


Emailing information eliminates the concern about availability and schedules— though typing takes me longer than talking! I edit, and double-check, and it takes twice as long; so though I've now delivered the written message perfectly, there is no guarantee about the timing of responses to my information and questions – and it may be that the doctor's responses will create follow up questions.

In the above examples, notice the doc and I each were available to the phone when the other called. I happened to be available at the same time she was – a seeming miracle in this day and age. Doctors will often tell their staff, "Just pull me out of an exam room if a colleague calls.” But as a MFT, I don't have that "luxury,” nor do I want it: I personally hold to not interrupting client sessions to answer the telephone, similar to most of my MFT colleagues. Mutual availability is the barrier to direct, interactive communication, but is so worthwhile to getting the richer data and helpful informational exchange that I seek.

Building the Collaborative Care Network One Quick Call at a Time

We all need a rubric: Whether we're requesting information and sharing it via letter, email or telephone with a medical practitioner, we probably have a preferred list of questions. And alternatively, if we're making a referral, it's useful to have a standard presentation: we've seen the client for this long, diagnosis, purpose in referring. Doctors tend to talk in short, purpose-driven sentences, right to the point. We therapists ponder the human condition and wonder about possible outcomes. I've learned to keep it short and sweet, tailor a basic set of questions to the needs of the individual client's situation, focus on the answers so that I can attend to thorough, though brief, follow up questions; this is my compromise to seeking "richer” data by telephone, but following the "all-business” route. The good news is that, if you catch the doctor between your clients, there's a good chance you will get the information you need quickly. They talk fast, and I talk – and listen – as fast as I can!

And final thought: Since I do things by telephone, I almost always offer to send cards, and I ask them to send some in return, once they receive mine. We create networks, we become familiar with each other's treatment philosophies, and we become a community of collaborative care practitioners!

Julia B. Sayre is a licensed MFT, Certified Traumatologist and AAMFT Approved Supervisor practicing in Northern Virginia. Julie holds an avid interest in medical family therapy, supported by a strong belief, steeped from the first days of her clinical training, in the collaborative approach. She received her B.A. from the University of Virginia, her M.S. in Human Development/MFT from Virginia Tech/Falls Church, and maintains ties to VT through the occasional service on a thesis committee, most recently regarding original research in medical family therapy. She also serves on the Board of VAMFT, Virginia's division of the AAMFT, and is a member of ISST-D. She and her spouse form a stepfamily, "whose genogram looks something like a hybrid tree-shrub with a few hanging vines. With really nice flowers.”

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