I am not a sommelier, but I know what wines I like. I am a retired nurse with forty years of experience in Critical Care. I believe I am qualified to discuss the broken state of our health care system. It suffers a compound fracture. Early in my career, Primary Nursing, a practice in which one nurse agreed to be active in the care of a patient throughout his ICU stay, was introduced on our unit. It facilitated a holistic approach to care. At least one nurse knew more about the patient than his diagnosis and room number and helped that patient navigate the trauma of critical illness. Primary Care did not last long. It was time consuming for nurses already working short-staffed. It was costly, as Primary Care nurses spent time away from task accomplishment addressing the total patient. Now, after a recent short stay in the hospital and a more recent health jolt, I realize things certainly haven’t gotten better. I have had MS for decades and have strived to maintain the highest level of wellness. My PCP encouraged me to go to a local MS specific clinic for care. I went every year. The providers watched me walk, checked my neuro signs, assured me exacerbations declined with age thanks to an aging immune system. I was trusting. I accepted what I was told. I kept my routine appointments. When my knee began to bother me, I didn’t think about MS. I went to a knee specialist who watched me walk, did an x-ray, saw no arthritis, injected my knee, and sent me on my way. I followed up again when the pain recurred. Another x-ray, another injection. When that shot wore off, I learned to live with the pain. Then, after suffering a Closed Head Injury due to Covid induced hypotension, I switched neuro clinics and ended up at a clinic closer to my home. I saw a new MS doctor. In two visits, he changed my life. He watched me walk. I’d seen my gait in the windows as I walked into the gym. Aging I told myself. “You have footdrop,” the doctor said. Gutpunch. MS finally left its mark, less painful than my burning paresthesias, but so VISIBLE. Yet no one had told me. I bought an ankle brace online. I’ve learned to wear it on the treadmill. My knee doesn’t hurt. My leg is more stable when I walk. Where is the breakdown? The breakdown exists because there is a lack of collaborative practice. Just like the Primary Care concept in nursing, if my PCP, knee doctor, and MS doctor had even had a phone conversation, might I have learned of my footdrop sooner rather than later. Could this type of practice ever happen? I doubt it. The other part of the breakdown: Who would get reimbursed? What would the billing code be? Who would lose money if I’d just bought a brace? How much is one phone call worth to the practitioner? To the patient? Has medical specialization destroyed the healing art by disallowing the opportunity for a patient to be treated as a whole? What professional do I see to answer these questions?
Collaboration might be needed.