Two years ago I was getting bounced around between several doctors as they tried to figure out why I was struggling to breath. The rheumatologist felt I should see a cardiologist. The pulmonologist felt that I needed to be treated by the rheumatologist. The internist insisted that the pulmonologist needed to intervene. The rheumatologist was very reluctant to give me an inhaler even though he had ordered the PFT that indicated that I needed one.
I was getting close to pulling out my hair! Literally, there were too many cooks in the kitchen and no one could manage to get the meal assembled. I was the cake in the oven, and I had just collapsed into an ugly, doughy mess…
“Look”, said the rheumatologist in the middle of this, “you are the only point in common between all of your doctors. Each one of us sees just one slice of your health, but you are the one getting all the info…” In effect, she was telling me to take charge of my health. Uh…
Seriously? I’m expected to organize this circus? I have skills, but to suggest that I should run this show is ludicrous…
Except, from a certain viewpoint, I am running the show; I AM the show. I have a serious illness, and I have a team of doctors to address my symptoms and halt my disease’s progression. I need to be proactive and ensure that I get the treatment that I need. Clearly, I needed help to sort through the conflicting advice and to assign priorities to the elements of my treatment plan.
There needed to be one doctor who knew me well, understood the big picture, who could also cut through the red tape and facilitate immediate medical response from the most appropriate provider if needed.
I made an appointment with my internist, who was also my primary care physician, and laid out the problem. I told her that I needed someone to review all the notes and test results from the other doctors on a regular basis to understand the big picture. I shared with her my concerns about differing information from the other physicians: I needed an expert to work with me to coordinate my treatment plan. There needed to be a doctor who saw me on a regular basis, who knew me and my situation, who could take a “snapshot” of my health situation, and who could see me almost immediately if I got into trouble. One of the problems that I struggle with is knowing which doctor to call when I develop problems; with this arrangement I have a designated first contact who will decide which specialist needs to be contacted next.
We agreed that I should come in every three months for the medical review and snapshot of my current status.
Everything changed for me. My internist reads everything from the other doctors at these appointments, and she answers questions that I have in a cross-disciplinary way that the other specialists can’t. It’s more like a consultation than the usual medical appointment. She looks to see what has been missed by the other doctors, and facilitates communication between the doctors. She has sent me for immediate testing, cut through the red tape so I could get oxygen when I needed it, and makes sure I get the complete text of all testing reports.
I make an appointment with her before I see the specialists to plan for those appointments, and then I see her afterwards to debrief on what happened and to see if anything was missed. When I go to my appointments with the specialists I can talk about test results, my prescriptions, and the symptoms that are concerning me; I have become an informed patient. Because of this I am a better conduit of information between the doctors, and the coordination of care and smooth communication has greatly increased. My doctors and I are now collaborative partners working to manage my disease.
From a collection of 6 doctors I now have a smoothly coordinated team to jointly treat my illness. For me, this is a huge difference! I’m now in much better shape, and I feel more in control of what is happening. I AM the only point in common, so I had to activate my hidden superpower of facilitation and coordination to make it work.
And knit. I had to knit a lot.
Have a good weekend everyone.
Yarn, Books & Roses 
This makes SO much sense, but I wonder if what you’re doing with your team is the exception rather than the rule. Thank goodness you have the knowledge and skills to take this in hand!
I’m amazed that it took me so long to take the initiative to ask for this, and I do feel that it is the exception. I make an appointment and pay to sit with a doctor who reads all the notes from my other doctors, answer questions, and then offer advice or order additional testing. It costs me a few hundred dollars a year to do this, and it is worth every penny and probably saves me money in the long run. I’ve written a letter to Kaiser to suggest that they offer this to other patients with complex health issues and multiple doctors.
I’m sure it would be worth much more than a few hundred given what’s at stake. I bet having this oversight and the peace of mind it gives you is worth almost whatever it might cost. Thank you so much for putting this out here! You’ve certainly empowered me to look at things in a way it never would have occurred to me to do otherwise.
Thank you. The biggest impact is that I don’t feel as helpless as I once did. That is huge, and worth every penny I spend for the consultations and oversight.
When I was very suck, my general oractioner took over for all my soecialists, he made sure I was getting better not test and tests! Then he told me to take charge and be the one to make a ducision… Good luck and feel better xx