Judson Haims: Elder patients need a steady captain to coordinate health care
Special to The Aspen Times
The doctor-patient relationship must be a team approach.
The days of a primary care physician (PCP) managing their 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. Thus, the advent of specialists.
There are benefits of having a specialist address the intricacy of our medical concerns. While it may provide a higher level of thoroughness it also fragments the delivery of care.
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Take for example my mom, a 78-year-old, physically fit woman with Parkinson’s who, a couple of years ago, had a mechanical 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 to allow time for swelling to dissipate and further assessment.
In under 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 they specialize in and each had their own approach to address a remedy as it pertained to their specialty. Unfortunately, her condition did not improve much.
Frustrated and in search for answers, my brother arranged an appointment with a hematologist. After a thorough exam, detailed blood panels and a number of 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.
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 for change 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, 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 PCP, she is in frequent communication with her PCP. 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. For elderly patients, it should come as no surprise that their medical needs are more complicated. Elderly patients are often complex patients with symptomology that may be atypical and complicated by normal changes of aging and chronic disease — 10 to 15 minutes is rarely enough time.
At a time when PCPs are often expected to see more patients and accomplish a lot of work during their brief visits, it’s becoming more common for PCPs to avoid older patients due to the PCP’s limited bandwidth to see complex, time-consuming patients.
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 if the PCP could take the time and personal initiative to communicate with specialists, I think we’d see less frequent visits and our elders would have an improved quality of life.
On behalf of our clients, Visiting Angels collaborates with almost every medical office on the Western Slope. We take clients to medical appointments, ask questions, take notes, share information with family members and assist in disseminating information.
Many of our clients do not understand their own needs and it can be a complicated dance coordinating their care. We are so grateful when local medical providers are receptive to collaborating with our office and support us in sharing the responsibility of care and advocating for clients.
While many medical groups collaborate with us, Aspen Medical Care in particular has consistently exceeded our expectations when it comes to communicating the condition and needs of our clients. They have given us invaluable support and have fostered a caretaker-physician relationship that feels like a genuine partnership in advocating for our mutual clients.
Quality of life for our patients is one of our highest priorities. We do not have a banner within our office or a company mantra painted on a wall stating our mission statement.
However, if we did it would read: Advocate and exceed expectations at all costs.
Judson Haims is the owner of Visiting Angels Home Care in Aspen, Basalt and Carbondale. He is an advocate for our elderly and is available to answer questions. His contact information is http://www.visitingangels.com/comtns, 970-328-5526.
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