Sunday, May 22, 2011

Our Tenuous Medical Homes

It was just a visit to manage her paroxysmal atrial fibrillation. She was long overdue for the visit. So she arrived as she had so many times before: with little fanfare and folderol. She sat patiently after her weight was obtained, vitals recorded, and medications verified. Clutching her purse, whe sat patiently as the examination door opened.

"Hello, Ms. Smith, how have you been doing?"

"Wonderfully, doctor. I haven't had any more problems with my heart rhythm." She leaned sideways to put down her purse on the floor next to her.

"Any dizziness, lightheadedness, shortness of breath, cough?..."

"No, I'm doing fine, thankfully," her eyes glistening.

I proceeded to complete her history and catch up on a few details with her, then moved on to the physical examination. I watched as she got up on the exam table and noted her moving a bit more slowly than I had recalled.

"Is your strength doing okay?"

"Oh sure. Never better. Just slowing down a bit is all. But I'm not sure how well I'd be doing if it weren't for my daughter."

"How's that?"

"Oh, well, I'm her caregiver. Diabetes, you know. She's blind now, lost a the lower part of her leg... horrible disease, really. But she's my reason to keep going..."

I realized I had been caring for her almost ten years, but had forgotten an important detail: "How old is she now?"

"Fifty-eight."

"Is there anyone else who could help you?"

"Not really. My brother lives quite a ways away. He's been urging me to move, and I'm sure it'd be easier if ithere weren't two stories there, but it's our home! I just don't think I could bear moving ..."

I completed the examination, discussed her management, then refilled her prescriptions. As I completed her final paperwork I had to decide when to see her next.

I paused, not sure of the time interval to propose for her to return.

A month? Three months? Or maybe six? It's hard to decide when you're seeing such a remarkable ninety-one year old.

"Six months would be perfect, doctor," she said. "I hope I can see you then."

-Wes

3 comments:

drdarrellwhite said...

Very Sweet, Wes. Sounds like she was saying goodbye to you. So much to learn when we as specialists (I'm an ophthalmologist) take just a couple of moments to listen to the rest of the story, eh?

Darrell

Lynda Halliger-Otvos said...

Really poignant and touching; reminds me of my paternal grandfather taking care of my aunt with muscular dystrophy. Thanks for the memory.

Anonymous said...

But if you don't document it, and document what you documented, and then document meeting criteria across your entire patient population, your interaction with this patient is considered worthless and dosen't meet NCQA standards for a medical home.

Pathetic.