Who should be calling the plays

Monday, June 15, 2009

In the midst of the ongoing debate about potential health care reform, perhaps medicine should look to football for guidance in how to get efficient, coordinated care to the patient. In football, the head coach, with advice of assistants, decides upon the direction the team will take over the course of a season. Will they focus on offencs or defense? Will they concentrate on the run or the pass? What will happen at training camp to get the job done?

From the individual patient’s perspective, much can be learned about having one person in charge, gathering advice from a variety of sources and then getting a game plan together to make it happen. While it seems obvious as to who should be in charge, this role is often abdicated by the patient.

Being healthy is hard work. There are immunizations, screening blood and other tests to be considered, many on a yearly basis. There are prevention programs for diet and exercise to keep fit. With new research and studies published daily, the sheer weight of medical information can overwhelm the individual patient, making it easier to turn the decision making over to somebody else. It seems that there is too much work to make an informed choice, even about routine things.

When illness strikes, it may be even harder to take control. This is especially true when specialists get involved. Each one takes care of a little part of the body but often, the whole person gets lost in the process. The patient needs the assist of a good offensive coordinator to help put the whole game plan together. That way, heart medication recommended by the cardiologist won’t interact with reflux medication prescribed by a gastroenterologist and antibiotics given by a lung specialist won’t affect the anti-coagulation medications prescribed by the neurologist.

Ideally every individual should have a health professional who can sift through the information appropriate for that specific patient. That health professional may change as the patient ages or it may be a family practice physician who cares for the whole family from cradle to grave. It could be a pediatrician for a child, an obstetrician for a woman of child bearing age, an internal medicine physician for a middle aged man and a geriatrician for an elderly couple. It may even be a nurse practitioner or physician assistant.

But there has to be somebody who sits at the right hand of the patient and can coordinate the tests, the medications, the treatment plans and represent the wishes of the patient to the rest of the medical community. And that person has to listen to the patient, the person who ahs the ultimate call.

It may be that the patient should be considered the quarterback of his medical team. In football, the head coach makes certain that the players are well prepared and even provides the next pay to the quarterback, but at the line of scrimmage, it is the quarterback’s decision to run the play as called or to change to another strategy. In the world of medicine, the doctors, nurses, pharmacists and therapists all give the best advice they can, but ultimately, the patient decides the next play. For those making health care policy changes, hope should remain that those patient decisions should be respected.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.