What kind of doctor can be in charge here?
February 13, 2018 2:38 PM   Subscribe

A previously vigorous healthy 74 year old friend has suffered one health setback after another. A million specialists, but no one seems to be in charge and friend is too ill and fatigued to be her own advocate.

What once seemed like one illness that could be cured has blossomed into numerous specialist referrals with seemingly no one in charge or taking into account the findings or treatments of the others. No one ever seems to do more than glance at her chart and if there is not a savvy alert family member in the room with her to intrusively, concisely and clearly insist on the current doctor hearing important bits of medical history like medications or compromised organs things will be prescribed/started/instituted that are not appropriate that have ended up with her back in the ER. Such family members are in short supply and have limited availability and/or are far away.

Surely there must be some medical specialty that falls under "being in charge" or "seeing the big picture." She needs this specialty! Friend is in the U.S. near Washington D.C. with good health insurance.

Thanks for any insight into this problem you might have.
posted by Jenny'sCricket to Health & Fitness (9 answers total) 3 users marked this as a favorite
Would she be able to pay out of pocket? I have a potential referral for you if so.
posted by LobsterMitten at 2:43 PM on February 13, 2018

Is your friend's primary care doctor a geriatric physician? That can make a lot of difference (as my spouse and I saw when we switched my mother-in-law to a geriatric PCP). This might be a good place to start in finding someone.

Good luck to your friend (and thank you for helping her)!
posted by the return of the thin white sock at 2:53 PM on February 13, 2018 [6 favorites]

Ugh, I'm stuck in this hellscape too. I sorely miss Kaiser these days, they did this well. Any chance to switch to an HMO? One with nurse case managers?
posted by fshgrl at 2:57 PM on February 13, 2018

This is exactly what primary care physicians do. (Some better than others.)
posted by i_am_a_fiesta at 3:13 PM on February 13, 2018

While she is actually in the hospital this physician is called a Hospitalist.
posted by BoscosMom at 3:42 PM on February 13, 2018 [2 favorites]

What you're looking for is a Nurse Care Manager. Either your friend's insurance company can recommend one or there are others that can be paid out of pocket. There were several that cropped up when I did a Google search for the DC area.

My in-laws utilize a NCM for my FIL and she has been worth her weight in gold. She works in tandem with his geriatrician and coordinates *everything*, in addition to keeping the family updated as to what's going on with him, his physical therapy, testing, nurse visits, aides, etc.
posted by dancinglamb at 4:09 PM on February 13, 2018 [2 favorites]

One other thought would be to advertise for an RN that is not working or is only working part time. This would be right up their alley. You could pay them hourly or a day rate.
posted by dancinglamb at 4:11 PM on February 13, 2018

Massive gold star to you for seeing this break in your friend's circle of care and having the foresight to look for solutions! Many seniors fall into these kinds of cracks in the health system and stay there; you are a good friend.

IANY geriatric social worker, and I work in a different state, but she needs some kind of care/case management. She might qualify for nurse case management through her insurance, there may be low- or no-cost programs available near her through the government or nonprofits, and there are always, always private pay options. Care managers can be nurses, social workers, or other clinical specialists, so I would broaden the search term to "geriatric care manager" instead of just "nurse case manager."

The primary care physician should be the main point of contact and all specialists should be communicating with the PCP. The PCP should be keeping track of the various treatments, team members, etc, but that doesn't solve the problem of needing an extra listening ear in the appointment. A case manager will either go with her or communicate with the doctor and be her advocate. There are also some case managers who will work on behalf of out-of-town children, and keep them caught up with what's going on with your friend's health.

I would start with the area Agency on Aging. In DC this seems to be the DC Office on Aging. They will have information and referral services and may have the option to make an appointment to discuss things further, or refer you to a more local office that can give more specific referrals. DC is an "age friendly" city, which means they've met certain requirements to have available resources for seniors, but they can be hard to track down without help!
posted by assenav at 7:07 PM on February 13, 2018 [2 favorites]

When my father became ill, we hired a patient/family health advocate. The person wasn't affiliated with the insurance company like a customer care advocate would be, or with the hospitals/doctors involved. She was in the room with us when doctors spoke with us about options, and explained what was happening in a really accessible way, and was able to point us towards options/resources we had not considered. It seemed to me that she did some of the things a primary care doctor would do in terms of looking at the overall patient care across multiple doctors/issues, but she was there all the time. There's a professional association that might allow you to find one in your area.
posted by answergrape at 8:53 AM on February 14, 2018

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