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In Charge, Really?


The best persons to be in charge of a patient’s medical care are the patients themselves.  Not the primary care physician, not the legion of specialists, nurses, and other health care professionals, not the insurance companies, but the persons most concerned with their health: themselves.  This is something of a break with tradition where the primary care physician (PCP) assumed overall responsibility for what happened to their patients.

Today, if you have a medical problem on the weekend, there is a good chance that your PCP or the on-call Doctor will tell you to go to the emergency room.  If you are in the hospital, the physician you see will be a hospitalist or a specialist, not your PCP.  So, within the medical system, no one is in charge.  In many cases, this works out and there are no problems.

However, there can be problems in continuity of care because no one has time to read a patient’s entire chart.  Things can be missed, the wrong drug prescribed, a drug interaction occurs, or side effects of drugs are diagnosed as a separate condition and treatments prescribed when the first drug is the culprit.

Frank was given Aricept in Florida when a neurologist diagnosed him with Alzheimer’s.  Soon after he began taking the drug, he became noticeably weaker and more lethargic.  As the link indicates, these are side effects of the drug.  When Carol questioned the neurologist about the diagnosis, he said, “What difference does it make”.  Frank drank.  He very well may have had alcoholic dementia rather than Alzheimer’s.  Aricept may have done more harm than good, but we will never know.

At the time we were long distance caregivers with a geriatric case manager handling things in Florida.  She was good, we did our best from across the country, but no one was in charge on a daily basis.  Frank could not be in charge of himself by that point.  We did our best, but was it good enough?

Recently Carol had surgery.  We are experienced caregivers and practiced at being in charge.  The prescription for pain Carol got from the surgeon included ibuprofen.  Carol does not tolerate any of the NSAIDS.  We missed it.  Then when she needed a refill of the correct drug, the surgeon was not available. The office staff person said she would get another physician in the practice to write the prescription.  When I arrived, the prescription was not ready, and after a wait, another doctor rushed out with the prescription.  At the pharmacy, I could not get it filled because the dose amount was omitted.  I did not catch it at the doctor’s office.

Steve just had surgery.  His father and I shared caregiver duties.  Steve ran out of pain medication on my watch.  He got through it OK, but it was the weekend and his pain was worse than it could have been.

The gist of all this?  The patient or the loving caregiver has to be in charge.  Being a patient or caregiver is stressful.  Mistakes will be made, but with someone in charge outside the medical system they will sometimes be caught before there is lasting harm.  Some years ago I went to Emergency Medical Technician school.  The first thing we were taught was:  Above All Else Do No Harm.  Let’s hope those in charge keep this in mind and do their best to assure there is no harm.

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