Haims: Doctor-patient relationship a team approach to provide appropriate care (column)
May 14, 2018
The days of a primary-care physician managing a patient's total health are, for the most part, gone. Physicians who once provided comprehensive care from birth to adulthood are being replaced by an ever-increasing number of medical providers — obstetricians, pediatricians, family physicians, neurologist, cardiologists, pulmonologists, nephrologists and oncologists, to name just a few.
The understanding of the human body and medicine has become increasingly advanced and specialized. No one medical provider is likely to have a thorough and comprehensive understanding of the entire body, and while there are benefits to having a specialist address our medical concerns, it can also fragment care.
Take, for example, my mom, a 78-year-old, physically fit woman with Parkinson's who, a couple of years ago, had a fall and suffered a broken arm. She went to the hospital for treatment, a brief medical history was asked by an attending physician, and many hours later, she was released home with a bottle of pain pills and told to return in a couple of weeks for further assessment.
In less than a week, my mom became highly agitated. She complained that she could not think clearly, sleep had become compromised, and while she understood the pain medication may leave her feeling groggy, she said her energy had disappeared and she had difficulty motivating herself to get out of the house. Adding insult to injury, she found she was losing her appetite and had started developing acid reflux.
My brother took her to an endocrinologist (thyroid specialist), a gastroenterologist (digestive system specialist) and a neurologist. All ran tests on the sites in which they specialize, and each had an approach to address a remedy as it pertained to a specialty. Unfortunately, her condition did not improve much.
Frustrated and in search of answers, my brother arranged an appointment with a hematologist. After a thorough exam, blood panels and follow-up visits, the hematologist said my mom needed to revamp her medicine regimen. A number of the medicines she was taking were causing platelet and other concerns that were exacerbating her Parkinson's and health in general.
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This information came as a huge surprise to my mom and brothers. We had great confidence in each of the specialists she was seeing, and while a few of them had collaborated with one another, not all had. We were diligently trying to make each hear concerns better and never had considered we could be making other areas worse.
The hematologist's explanation as to why our family should support her oversight of all my mom's conditions was compelling. Further, after she spoke with each specialist, all agreed that her suggestions were worth pursuing.
The hematologist took the lead of my mother's medical needs and collaborated with all her providers. In time, my mother's condition took a turn for the better. The doctor took into consideration my mother's lifestyle, diet, medications and activity level and considered the family and friends who supported her.
I cannot stress enough the importance and effectiveness of having at least one medical person manage the role as captain of the ship or quarterback. While the hematologist is not my mom's primary-care physician, she is in frequent communication with her primary-care physician. They are providing comprehensive oversight and assisting us greatly in advocating for our mother. We got lucky.
In today's medical environment, primary-care physicians too often only have 10 to 15 minutes to see a patient. Elderly patients are often complex patients with symptomology that may be atypical and complicated by normal changes of aging — 10 to 15 minutes is rarely enough time.
At a time when primary-care physicians are often expected to see more patients and accomplish more work during brief visits, it's becoming more common for those physicians to avoid older patients due to the their limited bandwidth.
Though navigating the current medical environment is proving complicated, appropriate care would reduce costs by helping avoid unnecessary re-admissions. For elderly patients who may present multiple symptoms, medical providers who take the time and personal initiative to communicate with specialists help mitigate frequent office visits and improve the quality of life for all — particularly our elders.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. Contact him at 970-328-5526 or http://www.visitingangels.com/comtns.