View Full Version : "Tackling Care as Chronic Ailments Pile Up"

02-24-2011, 03:27 PM
New York Times article from February 21, 2011,
"Tackling Care as Chronic Ailments Pile Up" by Jane E. Brody



. . . [A] strategy report from the Department of Health and Human Services, say[s] more than 25 percent of Americans have two or more chronic conditions - which, by definition, require continuing medical care, and often limit their ability to perform activities of daily living. . . . As people age, their chances of having two or more chronic conditions rises, and Medicare expenditures rise with them. Two-thirds of Americans over 65 and three-fourths of those over 80 have multiple chronic diseases, and 69 percent of Medicare dollars are spent on people with five or more of them.
. . .
The new report, "Multiple Chronic Conditions: A Strategic Framework," was created to provide "a road map for the nation to foster changes in the health care system that can reduce poor health outcomes, improve patients' quality of life and reduce costs," said Dr. Anand K. Parekh, an assistant secretary of health who was in charge of the report.
. . .
[P]eople with multiple chronic diseases commonly receive disjointed, often conflicting care. That can lead to preventable hospitalizations and a host of avoidable complications, adverse reactions to treatment, and duplication of expensive, sometimes hazardous tests. Clinical practice guidelines have been developed to help doctors treat patients with many individual chronic conditions, but not for treating common combinations of them. As a result, what is recommended for one disease may counteract what should be done for another.
. . .
When no one doctor coordinates and oversees a patient's total care, or when patients neglect to report all the other prescribed and over-the-counter remedies they take, medical cocktails can become Molotov cocktails. Often, patients have no idea that a particular treatment is the cause of distressing new symptoms, which can result in an emergency room visit, hospitalization and a raft of costly tests. Even without such emergencies, patients with multiple conditions are often subjected to the same tests by different doctors, contributing further to needless medical expense.
. . .
Dr. Parekh stressed the importance of having a single doctor - usually a primary care physician - to serve as "the quarterback of care for individuals with multiple chronic conditions," the overseer who can coordinate all the patient's conditions, medications, tests and specialists.
. . .
But patients also have a critical role, Dr. Parekh said. They need to learn as much as they can about their conditions; tell the doctor about every medication and test taken, along with behavioral health problems like mental illness and substance abuse; and avoid risk factors like poor nutrition, smoking, alcohol abuse and lack of physical activity.
. . .

02-24-2011, 04:46 PM
Good post! This is something that many of us are dealing with. I used to have a PCP that I could trust to coordinate all of my care, but then I moved, and the one that I am stuck with believes that I might be a hypochondriac.
It seems that a good, well-trained network of PCPs might be the answer for those of us with multiple chronic diseases. I wish that our med schools would do a better job of training them!

02-24-2011, 05:57 PM
Yep, this is how it SHOULD be but how do we get there? I've noticed some doctors I've been to don't want me as a patient... I make them work too hard. You can tell which ones they are because they are dismissive and you leave feeling worse than when you arrived. Instead of being upfront and saying they don't want us as patients they mistreat us with the hope we'll just go away. One doctor I had wouldn't give me the pain medication I've been on for years. Come to find out 3 of his patients overdosed and he was being investigated. But instead of him being honest with me he made me feel like I was being a hypochondriac. It had nothing to do with me!! I feel lucky to have found a good and caring doctor and I hope it lasts. I try hard to be a good patient and she knows how hard I try. I've had several doctors start out good and end up mistreating me when I take up too much of their time with my illnesses. It's really sad.

02-24-2011, 08:01 PM
I agree. This is how it should be but very few of us get lucky enough to have it

02-25-2011, 08:18 AM
great thread! If only we can somehow get the doctors to realize the error of their ways in staying so isolated. They are doing us and themselves a diservice.

02-25-2011, 11:59 AM
Unfortunately, Sandy, it's all about money. I wouldn't totally believe this until my gastrointerologist explained it this last hospitalization. My condition could be surgically resolved but he said it wasn't a surgery any doctor in private practice would perform because of the time involved and the low amount paid by Medicare.

It's a 4 hour surgery and Medicare doesn't pay much. I was surprised he came right out and told me and I'm glad he did. He said it would require several surgeries in order to get all the weak blood vessels and no doctor would take on that much work.

He said my only option would be to go to a teaching hospital like UCSF or Stanford and they would have a student doctor do the surgery. The problem with that is the probability of puncturing the colon was high and that would lead to more problems. He didn't recommend I go that route and instead take weekly transfusions.

02-25-2011, 12:49 PM
You are so right - I have known for a couple of years it's about the money. I've worked in an industry with I have assisted life insurance and health insurance brokers for years and it's really ridiculous how much the dollars and cents affect the bottom line of the quality of health care. I've had several doctors tell me that they would chose to go with a different drug therapy or course of action if it weren't for the insurance companies. It's all so upside down. I get very frustrated with it all. The health of a countries people should not be dependant on the potential income of a private corporation's margin line. And the health care industry (in my opinion) should not be allowed to make a profit at the expense of people's lives and health or to influence policy in their favor by lining political pockets. It's really just all wrong to me and doesn't make sense. I guess I'm just too much of an optimist but I really do hope that one day things will change and I think it's the doctors who are the only ones who can push that since they are the middle men and women between the health care companies and the patients. I'm not even sure how they would do it without losing in pay - because that wouldn't be fair either - but I still hold faith that there is a way.