Medical Quarterbacking

http://www.NewsAndOpinion.com | Although patients are increasingly aware that the United States has the potential to deliver the world's best medical care, frustration with the system grows daily. We have previously discussed many of the root causes.

Additionally, many patients tell us that their major annoyance is weaving through the everyday medical maze. Thus, we feel everyone needs a quarterback to direct the plays once the patient has decided the basic goals and strategies. By this we mean a physician who calls the plays in the huddle, runs, hands off or passes as needed, directs the blocking, receives feedback from other players, reviews the films and is director of the medical team.

The most satisfied patients seem to be those who have a decisive internist or family practice physician who is in the take-charge position.

Out of roughly 650,000 practicing physicians, fewer than 40 percent make up the "general care primary specialties" plus "primary care subspecialties." To confuse patients further there are anywhere from 40 specialties to over 100 subspecialties.

The total number of patient visits in the United States in 2000 was 823,542,000, according to http://www.aafp.org/x794.xml. That translates to billions of diagnostic/therapeutic tests and procedures yearly that must be sorted and fed back to relatively few primary providers.

As the population, particularly over 65 and 85 increases significantly, has more chronic illnesses and diagnoses, and requires more treatment and medications, the potential for problems increases geometrically.

Says Sheila Pinsky, Orange County, Calif., "With all the medications, over-the-counters, herbs, spices, vitamins, supplements and tests, this gets pretty confusing for the senior population."

A Newport Beach medical internist who is well liked and respected by her patients told us: "My job as a well-trained internist is to follow every questionable finding to conclusion. Most specialists want to treat their area only but don't want to treat the whole patient." By "conclusion," she means until the finding is determined to be significant, non-significant or needing further study or follow-up. In other words, she helps the patient decide when to get off the medical merry-go-round/treatment treadmill.

We understand. Recently a relative of one of these writers had a body scan that showed an incidental "cyst" of a gland in the neck. Specialists were consulted. One specialty examined the neck, another checked the ears, nose and throat, and a third the thyroid gland. The anecdote has a good conclusion because the patient's quarterback meticulously reviewed all the findings and made a decision.

With the above in mind we recommend the following. Very little is brand new but sometimes going back to basics is the best way to win the game.

Previously we have suggested that everyone make a list of all medications, vitamins as numerated above. This includes names, appearance, indications for usage, doses, schedules and prescribing physician. Remember also, the pharmacist has an important role in today's medicine. Most have computers to check drug interactions.
Now add the names, specialties, addresses and phone numbers of your consulting physicians. Include the pharmacy you use and phone number. This vital information taped to your wrist or in your personal notebook will save you and your providers time and inconvenience and perhaps save your life!
Choose your primary care doctor carefully. This means not only his/her qualifications but whether you like and can relate to each other. If you don't get along say "So long!" You won't be able to communicate or coordinate only vacillate.
In general, most super or sub-specialists are not ideally suited, by training or inclination, to be your primary care physician. For children the general pediatrician is a good choice. For women most obstetrician/gynecologists are too specialized.
When you decide on a QB, meet and set up some rules of engagement such as how often to meet, talk and e-mail. Most patients get upset with long office waits. So make a deal. You will call if you are late for the huddle and ask that the doctor do the same! Providers and patients should both practice sportsman-like conduct!
To best utilize time, think out your message, comments and questions before entering the doctor's office. In the May/June 2003 issue of The AARP Magazine's Health Report by Elizabeth Austin, "I'm afraid I have bad news," she quotes author Joni Rodgers as saying, to prompt her doctor to listen. "I need to say something and if you promise to listen without interrupting, I promise to speak for 90 seconds or less."
Alert your Primary Care QB when you see a specialist and that a report will be coming. Report back any new medications prescribed.

Remember that with all the new rules and regulations on the turf, you must assume partial responsibility for your moves. Don't get sacked in the medical backfield. Make a medical QB your franchise player.

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Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical- legal issues. Robert J. Cihak, M.D., is past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

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