This article was originally published in a sponsored newsletter.
I think about collaborative care often. Maybe it’s because both of my sisters are also doctors and we like to discuss patient care. Or maybe it’s because of the many complicated patient cases I have had over the past 29 years that required collaboration with local medical professionals.
When we think of a patient with an urgent need, we never hesitate to collaborate. We call our colleagues and send notes, and then we schedule appointments for that patient. Once the referral appointment is complete, we schedule a return visit with us. The situations that are a little less “cut and dried,” as my farming family always said, are those that don’t require urgent collaboration…but it might be wise to initiate it.
A situation like this arose in my practice a few months ago. A parent came into my office with her 15-year-old daughter. The young girl needed to update her glasses and contact lens prescriptions, but also complained of intermittent itchy eyes when questioned. As I continued to talk to her about these symptoms and determine what her ocular hygiene practices might be, her mom jumped in and said, “It’s OK. I have her take Zyrtec daily as a precaution and it seems to take care of it.” At that point I had two choices: I could either assume that another doctor was on the case and had it “taken care of,” or I could dig a little deeper.
That day, I dug.
My response to the mom was, “Did her ENT or allergist prescribe the Zyrtec?” It turned out that no other doctor had been consulted for the allergies, and the Zyrtec wasn’t actually “taking care of it.” After a few more questions and a slit lamp evaluation, I determined that the main reason for my patient’s problem was likely that she was not being diligent about removing make-up every evening. I started her on a regular schedule of eyelid hygiene that included pre-moistened lid wipes and allergy drops as needed. We set up an appointment in one month and gave her instructions to come in sooner if this routine was not effective. A month later, my patient returned. Her symptoms had subsided and she was able to get off the daily dose of Zyrtec. I asked mom for permission to send a summary of the visit to her daughter’s PCP and wrote a quick note to the PCP as well so they would know what had occurred.
I’ll be honest: I almost assumed that my patient was under another doctor’s care and stepped away from both the conversation and the correct treatment. Had I not investigated, my patient could have continued on an unnecessary medication that was ineffective for her problem and could have resulted in withdrawal symptoms after prolonged use.
What if this patient had seen another doctor for this problem and had been prescribed this routine? I hope I would have questioned the patient in the same way and discussed the case with the other doctor. Our days are often long and our conversations can be tiring, but their outcomes are also extremely rewarding. Every time I’m tired or worry about stepping on another doctor’s toes, I remind myself that my patients expect me to do my best for them every time, no matter what. Part of that is collaborating with other doctors, even if it’s just by sending a letter. When we collaborate, we can truly facilitate effective care and promote innovative solutions.
