Caught in the Middle


One of the more difficult issues in health care is the volume of conflicting information and directions. Information bombards patients and physicians from all directions. Much of the information is biased, intended to coerce the patient to buy a product or service; benefit to the patient might be secondary to making a sale. Sounds cynical, but valid. With care being fragmented between primary care physicians (and their nurse practitioner or physician's assistant), specialists (and their APN or PA), emergency rooms, and hospitals (with care provided by their Hospitalist), it would be a miracle if all of the medical professionals agreed on the best approach. Communication rarely achieves the ideal required to get all on the same page.

Recently, a patient under my care for more optimized heart attack and stroke prevention had symptoms leading to a brief but intense hospitalization. Fortunately, the evaluation revealed it to be a false alarm. But he left the hospital with a complete revision of the individualized personalized approach we had started and had been converted to the "one size fits all” approach favored by the procedural specialist who cared for him in the hospital.

What should this person do? Follow the recommendation of the expert with more training in treating the late effect of disease or the recommendation of the generalist who is committed to the best evidence based preventive strategy possible?

Every situation will call for a different reply. But here are a couple of thoughts worth considering:

  • What are my goals?
  • Who seems most interested in me and my achievement of those goals?
  • Whose advice best fits my preferred style?
  • Who is going to be working with me in the long run to make adjustments if things don't go as planned?
  • Who is more willing to work with me to overcome barriers that might make the perfect plan difficult to implement?

I called the patient and laid out the pros and cons of following this new course of treatment. In the end, he chose to return to our earlier preventive approach. We decided together that the recommendation he received upon hospital discharge was not optimal for his individual circumstance.

It goes without saying that higher quality, better satisfaction at lower cost is possible as long as there is trust within a long term patient physician relationship. I'm biased, because that's what I do. But the therapeutic benefit of a trusting long term relationship is the reason I now practice in a more personal way than allowed for in more physician/provider centered practices. That may be provocative to some, but the evidence and real experience supports its truth.

Everyone should find a doctor you trust will act in YOUR best interest and work together to jointly determine your best individualize personal care. It is worth what you invest in this kind of care.