Friday, February 18, 2011

A Personal Medical Experience

I recently had a personal medical experience that showed me (a) how the health system can function well when its components, including the "consumer" (here, me) collaborate, (b) how simple technologies can make care more efficient and convenient, and (c) how some common sense ideas could make it even better.

On and off for a few years I've had pain in my hands. Not bad pain, but even minor hand pain can disrupt activities. The diagnosis seems pretty clear. An enlargement of the distal joint of my little finger fits the pattern of nodes that William Heberden described in the 18th century. (The nodes are now named after him.) They're part of osteoarthritis, typically caused by wear and tear.

Perhaps because of the cold winter and the nasty snow piles that demand shoveling that we've had in the Northeast, the hand pain was MUCH worse. I went onto the web and learned that osteoarthritis pain can fluctuate. That reassured me a bit. The web gave me some ideas about what to do, but the advice was confusing.

I didn't think I needed to see my primary care doctor, so I sent him an email on the secure system the medical group uses (I've edited it a bit and added some comments):
Dear X

I hope all is well with and for you and [your wife].

I've talked with you before about the on and off hand pain I've had. For the past month or so I've had what I surmise to be mild (but persistent) osteoarthritis pain, luckily, just in the left hand, since I'm right handed, so I've been able to continue playing tennis, etc. [The pain was actually rather severe, but I don't like to whine. In retrospect I see that I minimized it.] If I were still part of the [medical group] I would wander by to talk informally with one of the OT [hand therapy] folks in the orthopedic area to get some advice about exercise and other self management techniques. Do you think I should make a primary care appointment, or would having an OT appointment do the job?


My primary care physician wrote back that he'd made a referral to the hand therapist. Next thing I knew the secretary there called me to set an appointment.

I told the OT clinician that I wanted guidance about how to care for what I assumed would be an ongoing "challenge." She examined my hands to make sure I wasn't way off base in my assessment (I wasn't), made some baseline measurements, showed me a series of exercises I could do and ways of protecting the joints, gave me her card, and told me I could come back if needed. She explained it all and left me with some printed materials. I was a thoroughly satisfied "consumer."

But the health care wonk in me couldn't keep quiet. I thanked her for helping me, but said that my problem was probably not uncommon, and if her department had a class it gave every so often I would have gone to it. Hearing from others with a similar condition could be an additional benefit. I added that "you've explained things to me very well, but you may get tired of repeating yourself!" We agreed that a class was indeed a good idea, and she added that her department was discussing putting some of the materials she gave me onto the web.

Improving health care isn't rocket science. We want "consumers" to be engaged with self management. If they are, all sorts of resources are available on the web. We want everyone to have a primary care physician who knows them and who they trust. If that relationship exists, it provides oversight and guidance, even for a physician-patient. If the primary care physician is available on email, questions can often be answered without requiring an appointment. If the specialist is comfortable being an advisor and educator, the patient's self-management skills will be enhanced. When these pieces are in place, no one is tempted to order unnecessary tests. That's how an efficient, high quality, ethically guided health system, works.

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