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Fragmentation of health care.

January 20, 2012

Anyone who has had to go to more than one doctor to treat their health problems or has been in a hospital knows about this problem up close and personal.  Just getting two or more doctor’s offices to exchange records can be difficult.  Getting doctors to actually talk to each other about your well being is close to impossible, at least in my experience.

As diagnosis and treatment becomes more complex requiring increasing specialization in medicine, this fragmentation is becoming much worse, to the detriment of the patient.  Looking around online, there are innumerable articles about this problem, but little information about solutions.  For now the burden rests on the patient to coordinate their own care.

Electronic medical records are the widely recommended solution to this problem.  What many people do not realize is that there are many competing and incompatible electronic medical record systems being used by hospitals and doctor’s offices, not to mention imaging centers and labs.  These systems are not capable of direct communication with each other, so when records are sent from one office to another, they are still faxed and then either placed in a paper chart or scanned into a records system.  Another problem with electronic records systems is poor organization of data.  Where someone could flip though a paper chart and quickly note the information needed, often in an electronic system it takes much longer to find the information and it may be organized in a way that is difficult to read and interpret.

Besides problems in communication between providers, there is the problem of what to do when no one is willing to “own” your problem.  You may start at one doctor who refers to a specialist.  This specialist does not find a problem in their system so refer to another specialist.  This one does not find what they would be willing to treat so refer back to the first doctor or perhaps to yet another.  In between there may be long waits for appointments, time lost from work because of untreated symptoms or just taking off to go to appointments, anxiety about the lack of diagnosis and possibly more testing.  Sometimes no one finds something they want to treat, but the patient is left still experiencing the symptom.  Sometimes the next referral is to psych, which may be helpful for the distress of being shuffled from doctor to doctor without a treatment plan or if the symptoms actually stem from a psychiatric problem such as depression or anxiety.  But sometimes the original symptom is not psychiatric in origin and the patient is left feeling that their problem must not be that important or that they are losing their mind.

Sound familiar to anyone?  I have talked to dozens of people on support websites and in person who have experienced this dance.  I am currently engaged in such a dance myself.  I have fatigue, frequent angina, and anxiety.  I have a documented heart attack and vasospasm in the coronary arteries.  I am on seven cardiac medications.  Yet my cardiologist now states I have no “limitations” and is referring me to my psychiatrist for all matters concerning my current disability.  I have a good psychiatrist and acknowledge my chronic anxiety disorder which up until recently was well controlled.  It seems unfair to make her solely responsible for determining my capacity for work.  It seems like these people should collaborate and acknowledge the interrelated nature of my symptoms.  In addition, it makes me wonder what the cardiologist meant when he said he believed I have pain and supported me.  Was he just trying to avoid an uncomfortable confrontation?  Does he really think it’s all in my head?  Then what are all these cardiac medications for?  It’s very confusing.  I feel like I’m getting lost in the shuffle.

How have these issues affected you?  Please comment if you have a story to share.

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