People are always throwing around the term “care coordination” when discussing patient care and how to optimize it. I was previously taught the importance of care coordination across a patient’s providers and between the health system and the community, but I have only recently witnessed firsthand how the lack of coordination within the health system can negatively impair a patient’s health. Elderly adults have a number of co-morbidities, are on a number of medications, and see a number of different specialists. It is with these complex patients that I think it easier to slip through the cracks.
For a specialist, I believe it is easy to look at the problem you were consulted for, rather than the big picture. A patient yesterday informed me of the trouble he has had with his lower left leg pain; seeing several providers and each of them giving him different advice. An orthopedic suggested that he have surgery done; a nurse recommended increasing ambulation. It was a geriatrician who realized that the pain was due to spinal nerve compression, and a result of lumbar stenosis causing pain to radiate from the lower back all the way down his left leg. The geriatrician referred the patient to physical therapy, and the patient says ever since he began PT, his pain has decreased significantly.
A physician told me that the crux of the problem is that physicians are not stepping back to look at the big picture and thinking about how what they prescribe or what they do can cause more harm than good. In addition, some physician notes in the electronic health record may thoroughly detail a patient’s hypertension or coronary artery disease, but make no note of the patient’s advanced dementia and thus, do not realize that a patient lacks the mental capacity to comply with the physician’s orders and recommendations, and may also lack a support system to do so.
I believe that in an ideal world, different specialists should come together in one room and combine their vast and varying knowledge bases to efficiently come up with the most optimal (and probably the right) solution for a patient, seeing the patient as a whole rather than having one specific condition.