“Who’s in charge of the case?” the doctor asked a bit impatiently.
My husband was in the hospital, and his care seemed disjointed and fragmented. I was concerned and called his primary care physician (PCP) to ask advice. He hadn’t known my husband was in the hospital again and seemed frustrated.
I thought about his question for a minute and answered, “I guess I am. I am the one who talks to all the players and puts all the pieces together.” After a moment of silence, the doctor began asking questions and offering insights. With his help, I considered next steps for my husband’s care.
The situation begs the question: Who is supposed to coordinate care? A Harris Poll released in late 2016 found that nearly 70 percent of seniors either rely on a family member to coordinate their health care or, worse, have no one at all to manage their care. The survey of 1,000 seniors — many of whom have serious health problems, more than one medical condition, and three or more health care providers — also revealed that 63 percent have no one to coordinate their care following hospitalization.
Gone are the good ol’ days when a primary care physician (PCP) would oversee all care, including a hospital stay. Now, a hospitalist, who doesn’t know the patient, has responsibility for care management, but only until the patient is discharged. It is assumed that the PCP, who may or may not have knowledge of the hospitalization, will pick up the pieces when the patient goes home.
Being sick is bad enough. Lack of coordinated care can make a bad situation worse, leading to misunderstandings, confusion, mistakes and more. Information can fall between the cracks, be overlooked or marginalized. Patient misunderstandings and medical mistakes can have serious consequences, even death.
Over the years, my husband has been hospitalized multiple times for serious, sometimes life-threatening, illnesses. I have no medical training but lots of experience working in bureaucracies, running interference and getting results. So I have become his de facto advocate, playing a key role working with doctors and nurses, participating in medical decision-making and coordinating his care.
Some say my husband is lucky to have me involved and instrumental in his care. And I suppose that’s true. But solving the problems of care coordination would go a long way toward helping all patients benefit from health care delivery.
While we are unlikely to see overnight solutions to the problems with coordination of care, some efforts are underway, such as assigning nurse navigators to help guide and advise patients. Originally created to help cancer patients, nurse navigators are now working with other patients in some limited settings. Results can be significant for the patient, the family, and the medical provider.
Here’s another proposal that I would like to advance: Require hospitalists or attending physicians to consult with PCP’s when patients are admitted to and discharged from hospitals, nursing homes or rehabilitation facilities. And, add to that a requirement that, upon discharge, medical records are shared immediately— within 24 hours—with the PCP as well.
True, there may be some obstacles to putting this arrangement into practice, and it may cost hospitals and other facilities a little time and money to implement. But strengthening coordination of care can improve patient outcomes, reduce readmission rates and save lives. Results like that should be well worth the investment.
Bonnie Friedman is the author of Hospital Warrior: How to Get the Best Care for Your Loved One.
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