Stories like Dr. Madeline Biondolillo's keep me up at night. In a chilling account published in the Boston Globe, Dr. Biondolillo wrote about her mother's ordeal after she suffered a heart attack. Her 84-year-old mother survived, but there were several close calls during her hospital stay. As Dr. Biondolillo notes, her mother had the benefit of insiders to advocate and communicate on her behalf: two daughters, a doctor and a lawyer, both knowledgeable about how to work the healthcare system.
In the past, the primary care physician was the patient's health navigator and advocate. Today the primary care physician often doesn't follow a patient over the course of an illness due to the fragmentation of care resulting from specialization and increased use of hospitalists. Our national survey of 800 recently hospitalized patients reflects this trend: 62% said they never heard from their primary care doctor while in the hospital and 29% said they had not met the doctor in charge of their care before entering the hospital.
Perhaps healthcare innovations such as medical homes and accountable care organizations, concepts designed to improve coordination and promote accountability will help; but providers must make a special effort to communicate with each other as well as patients and their families so that patients don't get lost in the system.
Patients and family members should fill the communication gap by seeking out those who help them "navigate the shoals," whether this be through patient advocates at hospitals or representatives within insurance plans. Patients and families will also need to work with their primary care physicians to keep updated lists of medications, allergies, and medical problems, to ask about who is in charge of a hospitalized patient's care, and to insist on "appointment" times to meet with the doctors in charge to get updates throughout a hospital stay.
Following these steps is a good precaution but personally I won't sleep well until we see substantive reform of our healthcare delivery system.
Do you agree with Dr. Biondolillo that accountable care organizations are a way to address the problems in our healthcare delivery system?
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3 comments:
Communication problems run deep.
This morning Barbara Walters interviewed her cardiologist as a promo for her National Wear Red Day special "A Matter of Life and Death."
When asked by Elizabeth Hasselbeck if the tissue valve Barbara got 9 months ago would ever wear out, the cardiologist answered, "Why yes." With that Barbara screamed. She was hearing this for the first time on national television and it was clearly a shocker. Her surgery was at one of our countries best medical centers and I suspect the issue of longevity had been discussed prior to her surgery but this shows how, when faced with life threatening medical issues, we just don't HEAR everything.
When I faced my second open-heart surgery to replace aortic and mitral valves due to a congenital defect, my surgeon insisted I come with a second set of ears. When I arrived with a dear friend, he took the time to go over everything but at the end of the appointment, he told me that surgery would have to wait until I returned with my husband (who was finishing up a mission trip in Africa) before he would operate. While this was time consuming for him, it helped me understand how my best interests were as the top of his priorities. I will always appreciate him for showing that level of care.
Hi Rudy,
Thanks for your comments. Your experience is a good example of how physicians and patients, working together, can improve communication and ultimately improve outcomes. Your physician understood that informed consent requires more than just signing on the dotted line.
I think other patients and clinicians can learn a valuable lesson from your experience. I appreciate you sharing with our readers.
Julie Rosen
There's no doubt there is a disconnect and mis-communication between patients and their families and the medical staff (most often doctors). I think having an accountable care organization involved would be a good idea.
Jared Balis
Catastrophic Health Insurance Agent
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