"Things have become strained overall," agreed Dr. Keith Starke, chairman of the department of internal medicine at St. John's Mercy Medical Center. "A lot has do with the complexities that doctors and patients alike are dealing with."

Complexities that include extensive third party involvement, overtaxed physicians and frustrated patients, increased public awareness of medical errors, and a need for immediate gratification.

Still, Starke is optimistic. "Recognizing all these complexitites, being well-informed really does help with the long term process of care." In fact, "The more educated patient, the better," he said. And improved communication is critical, he emphasized.

An EPIC adventure

Starke is one of many local physicians getting proactive in his approach to improving communication. His office has recently converted to an electronic medical record system known as EPIC. "What will happen is one streamlined record," he said.

The e-record provides "one-stop-shopping" for all of a patient's medical history, including a complete medication list. This is especially useful given the current healthcare system that has patients frequently seeing multiple providers for a myriad of conditions. It also solves the issue of clinical disconnect amongst these providers.

"One of the biggest challenges is during the 'hand-off' of care when a patient gets discharged from the hospital," said Starke. "The electronic record will be a way of addressing this and will improve flow of information greatly."

Also using the improved communication systems are physicians at Saint Louis University School of Medicine and Saint Louis University Hospital. The Department of Community and Family Medicine was the first SLU department to implement the EPIC system.

"It is a powerful tool and a way to assist patients," said Dr. Gillian Stephens, a family medicine physician at Saint Louis University's University Club Towers location. "All information comes into one repository and allows us to establish a medical home for patients." A medical home is the cornerstone of family medicine and something family doctors are particularly adept at.

These electronic systems are also valuable for e-prescribing. And will likely result in "far fewer errors," Stephens said. "You write the prescription in while the patient is still there with you in the office. It is faxed over to the pharmacy and the patient can then go there to pick up the medication."

"But if you try sometimes, you just might get what you need..."

Establishing a medical home is critical in a system riddled with fragmentation of care. And despite wide reports on the on-going decay of family medicine, the department at Saint Louis University is thriving. A new family doctor will be starting this fall, having relocated here from Chicago. Dr. Christine Jacobs received her medical degree from Vanderbilt and family medicine training at Brown and now brings her 22 years of front-line experience to St. Louis. SLU also anticipates the fall arrival of a new chair, Dr. David Schneider, for the department of community and family medicine.

In addition to the establishment of a medical home, Starke offered some additional tips for getting the most out of office visits. "Have your questions thought out ahead of time. If you have several things on your list and don't get to them all, you may leave the office less than satisfied. Coming in prepared is the most helpful thing you can do."

And use the internet to your advantage. "The availability of the information on the internet can be helpful," he said, pointing to WebMD as a reliable site for patients. "With all of the so-called 'experts' out there [on the internet], it can be hard to differentiate the good from the bad." Starke recommends talking about it with your doctors and getting their recommendation(s) on where to go for more information.

Finally, no question to your clinician(s) should be off limits. "Ask the difficult questions," Starke advised. "Tell your doctor what you are hearing from others in your life. It is good to get that out there."