Fragmented Care Requires Clarification Of Roles By Each Member Of The Medical Team Health Care Advice

Fragmented Care Requires Clarification Of Roles By Each Member Of The Medical Team

This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care. Nope. It was a 62-year-old woman whose husband has been struggling with multiple myeloma for the last eight years and who herself has chronic back pain, high blood pressure and high cholesterol and was at the time well into treatment for breast cancer.

Part of me says “Ahem. Have you been paying attention here?” and another part says “Well of course! How were you supposed to know this? Have any of your physicians ever described their scope of expertise or practice to you?”

I can see clinicians rolling their eyes at the very thought of having such a discussion with every patient. And I can imagine some of us on the receiving end thinking that when raised by a clinician, these topics are disclaimers, an avoidance of accountability and liability.

But all of us – particularly those receive care from more than one doctor – need to have a rudimentary idea of what each clinician we consult knows and does. Why is this clinician referring me to someone else? How will she communicate with that clinician going forward? How and about what does she hope I will communicate with her in the future?

Why does our clinician need to address these questions?

Because in the absence of real guidance we will guess. Some of us will make informed guesses and be mostly right. Others of us will leave our primary care provider in the dust and seek care for routine health matters from our specialist, whom we see more frequently and who seems to know us better. Some of us, like my friend above, will ask for help from whichever physician is handy and will call back, regardless of the problem. And some of us will throw up our hands in frustration and head for the local emergency department when we find we can’t breathe and don’t know which of our doctors to consult about those damn allergies.

These ad hoc solutions are a waste of our time and surely contribute to a poor use of clinician and institutional resources.

Fragmentation of health care and lack of coordination of services are widely recognized as problems. Considerable efforts now aim to improve communication among providers when a person leaves the hospital, for example, and great stock is placed in the potential of the new patient-centered medical homes to “coordinate” our care (although the parameters of such coordination have yet to be defined).

There has been little or no recognition, however, of the fact that we patients and our families and loved ones are the main coordinators of all care: We decide when a threshold of discomfort has been crossed and we need professional help. We decide from whom and in what setting to seek such help. And for the foreseeable future, unfortunately, we choose to share the test results and treatment plans from one of our clinicians with another – or not. And we are doing this without guidance.

What would guidance look like?

Well, it doesn’t look like a website. More likely it has clinicians taking these small steps:

Don’t get me wrong. System-level fixes such as tailored online information, interoperable electronic health records with good patient portals and enhanced primary care will ease some of the redundancy and fill some of the gaps that now by default (and often without our recognition) fall to us to patch together. But at the end of the day, it’s my mom deciding whether to call the cardiologist, the neurologist, the geriatrician or 911 about my disabled dad’s sudden dizziness. She’s the one who coordinates his care.

She also needs help from her clinicians to fulfill this responsibility. As do we all.

Virtual Health Center