Specializing in diverting primary care

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A recent article in "Research Activities Report," an AHRQ publication, was titled “Primary Care Coordination is More Difficult for Patients Who See Many Specialists.” The study “suggested” that a patient's high use of specialists might strain the primary care practitioner's ability to coordinate care.

Really? We needed to research this? Come on! In long-term care we've kind of known this.

We have one attending, especially one with geriatric training, who has to approve of any specialty consultants orders. Gee, that does tend to make coordinating care a bit easier, eh? Now, don't get me wrong, I'm all for research, being the geek that I am. But sometimes you just don't have to spend a bazillion dollars to study something to know what the problem is.

I mean, recently my 87-year-old uncle had been in the hospital for over six weeks. He had been seen by every specialist they have available: infectious disease specialist, cardiologist, neurologist, pulmonologist and gastroenterologist. (Can you say “cha-ching!”)

And the longer he stayed in, the sicker he got. (Oh, and yes, they went there; they put in a tube because he wasn't eating “well,” and who wants to listen to me rake over the big hospital specialists because after all, I am just a nurse!)

Also, despite my cousin's asking, the hospital (whose city and state will remain unnamed) has no geriatrician with privileges. And there was not one doctor who was coordinating his care. Do we really need to research the problem here? (“Too many cooks,” as the saying goes?)

A physician mentor of mine, a past president of AMDA and the chair of the Transitions of Care committee, Jim Lett, has a saying I think is very appropriate here: “When you're a hammer, everything looks like a nail.” In other words, each specialist is focusing only on a single issue, and not putting the whole puzzle together as physicians like, well, Dr. Lett would.

A medical director hero of mine, Dr. Jonathan Musher, held a meeting of the local hospitalists and attendings and made them talk to each other, exchange phone numbers and agree to communicate about the patients transitioning between acute care and the nursing facility. He didn't need to research it to know it would work well.

So can't we just look at fixing the problem we know exists instead of spending funds studying it? Believe it or not, the study called for more research on protocols that would allow for appropriate specialist referrals that don't diminish the ability of the primary physician to manage the care.  

Hmmmm, more research!  Hey, ever hear of the telephone? It's this really cool invention by this guy named Alexander Graham Bell. Each party picks it up and they all communicate to each other about the patient so that they can coordinate the care. 

Radical, eh?

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC — a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet.

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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