Author Archives: Dianne Savastano

How to Choose – and Switch to – a New Physician

Recently, Healthassist Healthcare Advisor, Anne Jacoby, began working with a new client. During the evaluation process, she learned that both the client, Jake, and his wife and Care Partner, Elizabeth, had mixed feelings about Jake’s neurologist from whom he sought care for a movement disorder.

They set out to improve that relationship using many of the techniques described in our June 2017 newsletter. This included gathering all medical records, obtaining test results from outside entities, enrolling in a Patient Portal, making a list of Jake’s medical history and medications, creating a written agenda for an upcoming meeting, and practicing how to address the topic of the relationship itself.

When to make a change

Despite Jake and Elizabeth’s best efforts, their next meeting with the neurologist was unsatisfying. They did not feel heard, and at that point, held out little hope that things would improve. They knew that in managing a progressive condition such as Jake’s, the relationship with their movement disorder specialist would be critical to their lives for a very long time. So they asked Anne to assist with finding and interviewing a new neurologist.

Here are some things Anne helped them to do:

  • Investigate all the neurologists within a certain distance who practiced in the field of movement disorders. Specialists often become sub-specialists in the management of specific diseases – finding those with the appropriate skills and experience was critical.
  • Research the process by which second opinions can be obtained by these sub-specialists. Protocols differ by physician practice. For some, you must discuss your case with an internal staff member assigned to screen prospective patients. For others, you must send your request and all associated medical records in advance for review, before an appointment will be made.
  • Fortunately, Anne had guided Jake through the gathering of his records so he could easily deliver them to the office of the physician from whom he decided to seek an appointment. This preparedness allowed him to obtain a new patient appointment within two weeks of his request.
  • Research Jake’s insurance requirements to be sure he was following the guidelines for obtaining second opinions, thus ensuring future payment. This step is often overlooked, an omission that can result in administrative barriers and additional costs.
  • Create an agenda that included the topic of why Jake was seeking another opinion/physician. It contained “Communication Methods” as an item so that he could outline his needs for the future. (This time, if he were going to make a change, Jake wanted to ensure that communication would flow more readily.)
  • Practice what he and Elizabeth would say as they began the meeting. Phrases such as, “creating a partnership with my physician for the long term as I manage my progressive condition,” were used in the preparation.

Success

When the time came for the initial meeting with the potential new neurologist, Jake and Elizabeth were not sure they would be making a change. They first wanted to test the waters and, since Jake was not in crises, they had the time and space to consider their options.

As it turned out, Jake and Elizabeth were happily surprised by the first and second follow-up meetings with the new physician. All their agenda items were addressed, and the doctor followed-up by phone and email communication as promised after reviewing test results.

In addition, the physician provided Jake and Elizabeth with suggested resources to read, encouraged them to become involved in a local support group at which he often lectured and, most important, viewed their relationship as a mutual partnership among the three of them.

Summary

Unfortunately, the relationship with our physician(s) is an often overlooked aspect of successful medical care. Thankfully, with a little bit of preparation and coaching, most clients are able to maintain and improve the communication and connection they feel with their medical professionals.

When this is not the case, patients must feel empowered to make whatever changes they feel necessary to improve their situation.

The Importance of a Strong Patient-Physician Relationship

Recently, Healthassist Healthcare Advisor, Anne Jacoby, began working with a new client. As part of our standard process, she began by conducting a thorough evaluation. Both the client (Jake) and his wife (Elizabeth) were present as Anne asked about Jake’s medical conditions and the medications he takes to help them.

She also asked Jake to describe all the members of his healthcare team, including his primary care physician as well as any specialists he sees. Jake has a progressive neurological condition and, like most of our clients, a complicated medical history. He sees numerous specialists, one of whom addresses his movement disorder. Because he sees many specialists, care from each of them needs to be coordinated.

Jake and Elizabeth described the relationship they have with Jake’s neurologist; it was obvious to Anne that their feelings were mixed. Jake said it was “okay enough.” Elizabeth was not fond of the doctor and complained that he never gave them the amount of time they needed during appointments to discuss all the items that were on their minds.

Preparation is the key to communication success

Each of our new client evaluations ends with the establishment of a project plan and a list of priorities. Anne proposed the topic of, “Improving your relationship with your neurologist,” as one area of focus. Jake was intrigued by her suggestion (although not optimistic!); he wanted to know what he could do to make this happen.

The approach was two-pronged: To obtain all the information needed (during the interview process, Anne discovered some gaps) and to improve communication with the neurologist. As is usually the case, they began with the creation of a comprehensive agenda that could be shared with the physician at the beginning of the next appointment. Specifically, Anne suggested that they:

  • Gather all medical records related to the treatment of Jake’s neurologic condition. This required making formal requests, in writing, according to the health system protocol documented on the “Requesting Medical Records” page of the health system web site. Sometimes these requests can be faxed, mailed, or delivered in person. Jake decided to deliver his request in person so that he knew it was received.
  • Obtain diagnostic test results for recent CT Scans, MRIs and neuro-psych testing. There had been many of these over the last few years, some of which had taken place outside of Jake’s current health system. So additional medical record request protocols were researched and followed.
  • Enroll in patient portals. Jake received care from two different health systems, both of which offered online patient access. One-time enrollment in these allowed Jake and Elizabeth to continue gathering information as well as communicate easily via secure email with the physicians involved.
  • Prepare a comprehensive list of all medical conditions, medications and providers. This included everything, both inside and outside of the health system in which Jake’s neurologist practiced. The goal was to establish a comprehensive sharing of information among Jake, Elizabeth, and all physicians involved, to ensure the coordination of efforts and prevention of duplication.
  • Practice. Anne worked with the couple to help Jake get comfortable talking with the doctor and Elizabeth get comfortable fulfilling the role of scribe. In particular, they practiced how the agenda item of, “Our relationship / communication with you, my neurologist,” would be addressed.

Summary

An often overlooked aspect of successful medical care is the importance of the patient/physician relationship. Happily, and with some preparation and coaching, many individuals are able to establish a comfortable and effective flow of communication with the various members of their medical team.

Do these steps always work to improve the patient/physician relationship? No. In fact, and despite doing a wonderful job following the steps outlined above, Jake and Elizabeth eventually decided that a change was needed and went off to find a different neurologist for Jake (the subject of next month’s newsletter!).

Recommended Reading: Breast Cancer

Although it is not entirely clear which factors and to what degree contribute to the development of breast cancer, this article describes a summary of practical lifestyle changes that are helpful in this regard (and on many other levels too!).


The title of a presentation I gave last week was “Caregiver Concerns.” In it, I shared three troubling statistics:

  1. The value of unpaid care in the U.S. is $470 billion per year.
  1. The percentage of adult children providing personal care or financial assistance to a parent has more than tripled over the past 15 years.
  1. The total estimated aggregate lost wages, pension and Social Security benefits of these caregivers is nearly $3 trillion.

This article focuses on the crisis that this represents to women, in particular. As a daughter and “only child” of two wonderful parents, this is certainly relevant to my life!

After The Move: The Importance of a Care Plan

In long-term care facilities, the staff prepares a care plan that guides and directs the care they deliver to individuals. In last month’s newsletter, I recommended that you, as a family member, participate in the process of care plan development so that you can represent your loved one’s needs, wishes, preferences, and interests.

(In the event you meet resistance about participating in this process, make sure to relay the fact that Medicare stipulates that an individual [if able], family members, or someone acting on behalf of a resident, has the right to take part in planning care along with the staff of the long-term care facility.)

Care plans include a review of an individual’s health condition. The process of collecting that information may begin even before a loved one arrives and continues upon admission. It must be completed within 14 days. After that initial assessment, further assessments must occur at a minimum of every 90 days (more often as a person’s medical status changes). Ongoing assessments, when needed, result in adjustments to the care plan.

What’s in a Care Plan?

Examples include:

  • Personal or health care services needed, such as assistance with bathing or care of a wound.
  • The level of staff required for performing various services (e.g., a nursing assistant can assist with bathing, but a nurse would be responsible for wound care).
  • The frequency of services and necessary equipment. For example, bathing may be four times per week with the use of a shower chair; wound care may be delivered daily.
  • The type of diet as well as any restrictions or preferences.
  • Health goals and plans for future transitions (if any).

Your Role

In our experience, the most successful outcomes in transitioning an older adult to a long-term care facility, result from the active, ongoing and frequent involvement of family members.

Specifically, here are some things you can do to ensure success:

  • Once you’ve participated in the development of the care plan, be sure to obtain a written copy that you can use as a guide in the future.
  • Be present on site, often, and at different times of the day, so that you get to know the routines and all the staff. You’ll be able to observe the things outlined in the care plan in real time and see how they are accomplished.
  • If possible, share these responsibilities with fellow family members, so that the burden does not fall to just one person.
  • Meet often with your family team members to discuss your individual experiences. Designate one or two of you to attend the facility team/care-plan meetings and to provide feedback to the staff.
  • When providing feedback, remember to point out all the things that you appreciate and that are going well with your loved one, in addition to the things that may require improvement.
  • Develop relationships with all the staff involved. Get to know them as well as the administrative team.
  • Remind the staff that they have vast experience caring for older adults and you hope to learn from them. Remind them as well that you have vast experience with your loved one and that they, in turn, can learn from you.
  • Identify the responsible party who will develop a regular meeting schedule with the team. Ask for in-between meetings if issues arise.
  • Prepare for meetings by creating an agenda that you discuss, in advance, with the professional responsible for organizing the event. In our experience, facilities do a good job preparing for and relaying information they would like to share with a family, but not such a good job soliciting agenda items from you for discussion.
  • Outline the length of the meeting and allot specific amounts of time for each agenda item. Families often leave meetings feeling rushed and unsatisfied; your efforts in advance can improve this experience.
  • Take notes during the meeting and summarize the action items at the end. Discussion will often lead to a revision of the care plan, so be specific about that and obtain a revised copy within a reasonable amount of time.

Summary

Once you’ve expended the effort it takes to both transition a loved one to a long-term care facility and to assist them through the adjustment phase, it is our hope that you can become less of a caregiver and more of a family member, able to live in the moment with your loved one.

Although your responsibilities never go away, expending effort up front will pay off in the long run as you work within the village you’ve created around your loved one. The goal should be to support your loved one’s adjustment to his or her new home and new extended family.

Recommended Reading: Primary Care in U.S. and Other Countries

Here is a fascinating study that compares the United States to 11 other countries regarding factors associated with primary care coordination. Unfortunately, the US had the highest rate of poor primary care coordination. It is no surprise that adults with poor primary care coordination are more likely to be hospitalized and to visit the ER.

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