A Case in Point…
Earlier this year, it became apparent that my patient Ann’s heart condition had deteriorated to the point where I had to take bold action to save her life. Ann is an 86-year old widow, a former hairdresser, who had lived with her elder sister until her sister’s death three years earlier. Ann remained in her small home and enjoyed her independence. She was short in stature and obese but got around fairly well until an aortic valve condition significantly restricted the flow of blood to her body with the result of congestive heart failure and severe fluid retention. She went into the hospital and, with the involvement of a cardiologist and a kidney specialist; we were able to remove 20 pounds of fluid – her condition improved. The cardiologist and I made it clear to Ann that this fix would improve the quality of her life but that her life expectancy would be limited. I told Ann I would be surprised if she would survive another six months. Hearing those words she enrolled in hospice.
We had several follow-up visits and, at a recent one, Ann told me that she had been to see her oncologist. Inwardly I was surprised; Ann had survived bilateral mastectomies 40 years ago and was still going to an oncologist? Ann told me that the oncologist was concerned about her current anemia (low red blood cell count), recognizing that her breast cancer was a thing of the past. I asked Ann if she had told the oncologist about her condition and my thoughts on her limited life expectancy. Ann looked at me as if I was crazy. In my mind, I thought that the oncologist had not asked the right questions nor looked thoroughly at Ann’s hospital records. She must have just looked at Ann’s chart or current notes in the computer, and did not evaluate the entire picture. Despite being enrolled in hospice, Ann must not have been able to figure out that there would not be much need for cancer surveillance in light of her limited life expectancy. As Ann’s primary care physician and someone who attempts to limit unnecessary testing, I felt extreme frustration that my patient experienced unnecessary anxiety provoked by the testing the oncologist ordered. Furthermore, I was fully aware of her anemia and that her age and compromised kidney function was causing this condition.
In my experience, this instance of Ann’s fragmented care illustrates “the rule” and, unfortunately, not the exception. Fragmentation is one of the downfalls of the care provided in our American medical system today. Many organizations are mandated to use electronic medical records (EMR) to consolidate and share medical information to improve quality of care while reducing redundancies in testing. Ultimately, this reduces cost and improves patient outcomes. I believe we have a long road ahead to correct these inefficiencies within the current medical care system.
Who is responsible and how can we correct the problem?
What are your thoughts?
To a Healthy and Long Life,
David Bernstein, MD