, Gloucester, MA

March 11, 2013

Fishtown Local: Coordination and our health care

Fishtown Local
Gordon Baird

---- — Has this happened to you or anyone you care about?

It’s rapidly on its way to becoming the “new normal” in medical matters all across the country: Your elderly mother or uncle or cousin has to go into the hospital for a condition or accident, hip replacement, shoulder surgery, you name it. They treat her, rest and rehab her and send her on her way with a regimen of drugs to take. And she does.

But then, after a while, she begins feeling dizzy, disoriented or completely out of energy. She lies her head down at the table at breakfast and says she’ll be all right in a minute. Perhaps she gets the chills, while covered in blankets and sweaters, sitting in a chair. Maybe she even throws up while going through her day.

Suddenly her new hip seems less important than her energy, weight and endurance. Then you discover, she’s seeing the hospital surgeon’s office for her hip, another doctor for an infection that occurred while in the hospital and still another doctor, a dermatologist, for a rash that has broken out all over her torso since the operation.

She’s taking four powerful and high dose antibiotics from one doctor, while the next doctor had prescribed two different courses of antibiotics — three pills each — for the infection, at the same time the dermatologist has her taking still other drugs for the rash, as well as strong topical ointments in case it’s Lupus. And she already was taking a blood pressure and a heart drug and a steroid.

The upshot is that she is taking 10-12 pills a day, all different colors. And guess what — each doctor didn’t know what the others had prescribed!

When confronted (gently), in person, each of the doctors was flabbergasted when I showed them the list. They just didn’t know about the other docs. We had filled out their forms dutifully before going in to the appointments where you “List All Medications That You Are Taking” and circled all the duplicates and added asterix and exclamation points but by the time we sat down with the doc, no one had read the list on the charts to see for themselves. Was that for the office staff to discover at some future time in some back office?

Regardless, no one at any of the offices was aware of the triplications and these were powerful pills, too: Prednisone, Cephalexin, Doxycycline, Metoprolol and Proquanol. Taken on an empty stomach or too early or together or before lying down, each had its own bugaboo that would make her non-functional. Only by accident, almost, did we line them all up and read the labels and realize the combinations.

I spoke firmly to the doctors on her behalf that someone had to “quarterback” the effort. But therein lay the problem. There was no coordination that we all assume goes on so a doctor could know even what other doctors were involved, let alone what they were prescribing.

The hospitals out in Colorado — as in Gloucester — don’t allow the doctors to “make rounds” like they used to. Naturally, they want to bill the insurance companies, etc. for those services themselves, plus control the treatment. So, a GP would be in the dark during a period of recovery. They might just go on prescribing a patient’s regular old meds, in spite of a big jump in new pills. Plus, there are also pills for dental and vision procedures, which also require antibiotics with no channel of communication.

When I finally spoke to the dermatologist, not only was he grateful that we had interceded and basically stopped everything but one course of antibiotics and blood pressure meds, but he conceded that the exact same thing had happened to both his own parents in the past year — and he was in the industry! I begged him to be the quarterback of the meds, and he gladly agreed to do it. Someone had to, me Mum is 88.

On the plane home, both my seat mates told me a similar story as did the flight attendant. It became a mini-town meeting in which others chimed in their own versions of the “new normal.” As the dermatologist admitted: “It is so important to be an advocate for patients. So important to keep track of what they’re taking and to intercede as fast as possible.”

That can be hard from thousands of miles away, but it is even more important than ever. It’s a new world out there. Marcus Welby is nearly extinct.

Don’t let the ones you love get steamrolled by the impersonality of the mainstream medical machine. It’s running too fast for even the docs themselves to keep track without your help.

They mean well, but even they admit: It’s the new normal. Don’t assume anything . . .

Gordon Baird is a local actor and musician, co-founder of Musician magazine, and producer of the community access TV show “Gloucester Chicken Shack.”