If you sit down to do a jig saw puzzle, many people start by putting together the frame, it sets the stage, holds it all in, essentially it outlines the big picture and keeps it all together. I’ve watched my grandmother and my father systematically put together puzzles this way for years.
Then I watch the current trending in health care. Where once there was a family physician who knew you and your kids, who stood as a guardian over your general health management and maintained the big picture, quite often there is now no one. You see your cardiologist and your chiropractor, you take vitamins and supplements recommended from a variety of sources, you may see another specialist, by recommendation or due to symptoms, you go to a quick care clinic down the street for your coughs and colds because your primary can’t fit you in for another month and when you do go to your doctor you see a new PA or his partner or someone completely unknown to you. So where did the frame of the picture go? Who holds the understanding of the more complex workings of your whole person and not just the parts that each doctor or service has? Is this now the responsibility of the patient? If so – I think most of our society missed that memo.
At least 10 times a week, as I work to triage a person at the Emergency Room, as I ask a person about their medications and medical history I get answers like: “oh it’s all in your system”, “I take that little brown pill because my blood is low, you know the one? and that white one because my pressure used to be high”, “No no, I don’t have high blood pressure”. I get these answers from people with significant health history but they have no idea what it is, no list of medication, no ability to tell me what their allergies are. The Medical Health Records being implemented at hospitals across this country, generally do not talk to one another, we do not share information. There may be legacy information stored if you’ve been to a specific facility more than once, but if you never could tell them your history, they most likely don’t have it, and if your medications have changed, they have no idea. I find myself pleading with the public who thinks there’s some umbrella of information over them, to realize that they cannot depend on any of that.
Each patient should carry a list of:
- Medical conditions and surgical history
- Medications taken daily including over the counter, prescriptions and vitamins/supplements
- Allergies – both medicine related and non-medical (preferably with the reactions detailed)
- Specific wishes or limitations of medical treatment (Including advanced care directive, POST or other legal/medical documents that help enforce wishes)
- Emergency Contact Information & Health Care Power of Attorney if they have one
- Names of all doctors & specialists the patient sees
- Insurance Information
We say primarily this information needs to be carried by the elderly, but it makes sense for all of us. Also it is preferable to put a copy of this paperwork in a red envelope on the fridge at home or in a visible spot near the front door. Why? Because if something happens, you cannot trust that the facility you will be taken to has any information about you. They will usually try to find as much information as they can, but the delay in obtaining the health history could result in poor outcomes, duplicated studies, increased invasive procedures, allergic reactions, unwanted intervention such as intubation or CPR and so on.
You’re just the patient though, how were you supposed to know? The frame is gone, but somehow the majority of the public, still trusts that there’s somehow something or someone there with an understanding of their big picture.
I’ve known this is our status as a country for a long time, you can’t miss it when you work in the industry. Just how damaging that lack of communication and framework can be became startlingly apparent even to me in these past few weeks. I find myself wondering lately, how the majority of people survive hospital stays without a loved one or advocate who comes in and helps to put together the big picture.
Do you have a loved one with medical problems who needs help with big picture management? Are you concerned for yourself and how to put together your healthcare picture in a way that protects you going forward? The market is seeing new roles emerging such as geriatric care managers, health care navigators, and health care advocates, these are people who position themselves to help patients manage that full picture of their health care needs and services. These positions are slowly growing however, and not always offered by physicians offices. Also, most of us never realize until the moment of crisis just how much we may have needed someone like this to assist with our own health or that of someone we love.
Do you think your health care power of attorney will be able to do this for you if you become unable to speak for yourself? Have you talked to them? Do they know your medical history, do they understand your wants and choices?
These are all questions we need to be answering as we step up to a more active role in our own health management. Sometimes the best answer is getting help from an outside source, some people can manage this themselves, but please, I urge you, prepare, get help as needed and help us move forward toward creating a better climate of health care in this country.
If you are interested in discussing your need or desire for an advocate & navigator please get in touch! It’s time that we started putting the whole pictures back together!