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And so...what is MEDICAL care management?

I know, you're thinking, "That's odd, there's a doctor at my door!"

Well, it's been a few months since I started Geriatrics Planning & Solutions which is a house-call practice and I'm on a mission to reacquaint the world that doctors still do house calls and that there is tremendous value in it.

This week has been one of reflection- maybe appropriately timed as spring starts and many cultures will be celebrating festivals and holidays representing renewal and new beginnings. And as I have been going through client reports, data, referral sources, expenditures, and of course, taxes, I'm starting to think about how I can paint a clearer picture of what I offer. What is MEDICAL care management as compared to general geriatrics care management? What is it that I'm offering that is NEW and unique and a rebirth of good medicine (ok, a bit dramatic, but I am listening to the opening to Grieg's Peer Gynt Suite in the background (be glad it isn't the In the Hall of the Mountain King movement...)).

Don't get me wrong- I have deep respect for the geriatrics care managers I've worked with. They are an important group of people bringing organization and safety to older adults living in the community. And more crucially, they bring peace of mind to caregivers, loved ones, and other important individuals in a client's life by bridging gaps of communication and letting them know that this person is being cared for appropriately.

But, what do you get when you enlist the help of a PHYSICIAN who is doing medical care management? And especially, a GERIATRICIAN with over 22 years of experience in caring for older adults in all venues of care?

You get medical expertise, insight, perspective, experience, and guidance- a geriatrician who comes to the home of a patient/client and can do a comprehensive assessment that includes the medical history, medication review, functional status assessment, cognitive/memory screening, home safety review, and an evaluation of the social support network. With this comes a thorough care plan that outlines priorities in medical care, home support services and interventions, and how to proceed on a path ahead that respects a client's goals for care. And, of course, education about all the medical issues in language that you can understand. Top this all off with the fact that there are no time constraints- you get as much time as you need with the doctor to ask your questions, get them answered, and put you in touch with resources and plans that will start addressing the issues/concerns.

Take for example, a patient/client living with dementia. As a geriatrician, I can evaluate, diagnose, and prognosticate (meaning, help understand the course of the disease process), and clarify:

  • I can differentiate between the types of dementia that need to be considered as well as take the impact of other medical problems/medications/conditions on cognition- for example, hearing loss, depression, antidepressants, etc.

  • I can review the risks & benefits of medications and other treatment approaches to dementia so a decision can be made about pursuing them or not.

  • I can help you with caregiving support- education about what you are seeing, what may develop, what is out there to help, and how small changes in our approaches can make a world of a difference.

  • I can help you navigate the world of advance care planning so that the patient's/client's wishes and priorities for care are outlined and formalized. Furthermore, I can help you complete things like a POLST or DNR/DNI form (if applicable) and sign it so that it becomes a formal medical order.

  • If we need to review medications and adjust regimens or introduce new ones, I can do that as a prescriber and physician; and, I can monitor the response over time.

  • If we need to get therapies (physical, occupational, speech) or durable medical equipment (DME) in place, I can provide the referrals/prescriptions for those services.

  • I can review all the other medical conditions, treatment regimens, specialists' recommendations and evaluations and put that into the context of what is important for the patient/client in front of us right now and down the line.

  • Having practiced in office practices, hospitals, nursing homes, assisted living facilities, hospice care facilities, continuing care communities, and of course, home based care, I can give you a physician-based perspective on all of these venues. So, if a choice needs to be made about the next best option, I can provide you the guidance to make an informed decision.

  • I can connect you to resources and supports in the community so that you are not overwhelmed and the person can remain at home for as long as feasible.

  • I can be available by phone or in-person to provide you guidance and education- especially when or if a patient/client is hospitalized or in a nursing facility.

  • If and when applicable, I can help with providing compassionate palliative or end-of-life care to the patient/client, organizing services and treatment plans so that the final leg of the journey is comfortable and at home- not in the hospital or facility connected to tubes, drains, lines, and catheters.

  • As a physician, I can communicate more easily with other physicians, peer to peer, so everyone reaches a better understanding of what is going on and what options make the most sense.

In short- it looks a lot like what good primary care should be- having a physician at the center who can disentangle the web of medical information, providers, and medications, and point you and your loved one on a path that makes sense. This is informed and shared medical decision making at its heart. However, if you wish to keep your current primary care provider, that's not an obstacle. I can work with him/her to coordinate care and provide a geriatrics input to what's going on or planned.

And, when or if needed, I would point you to a good geriatrics care manager who can also help organize services in the home and out so that you or a loved one can remain safely for as long as possible.

So, medical care management that is geriatrician-directed is, in essence, a resource to help you make sense of medical complexity and understand what is going on. It is the central hub of a wheel that connects the spokes of medical conditions, medications, specialists and other providers, home-care supports and resources, education, and community resources. The answers to all the questions in the comfort of the patient's home and unfettered by time. Reach out and give it a try- I look forward to meeting you!

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