The Importance of Being on the Same Page

No doctor is perfect. My guess is that orthopedic surgeons are as tired of talking about the importance of weight loss and exercise as I am to what seems to be deaf ears. Worse, it's unprofessional to complain about other specialists[1], but my last two weeks have been a bit frustrating. 

• Patient was seen two years ago with "mild arthritis" in a joint. She was told by two orthopedic specialists that she didn't need surgery. Neither of them recommended physical therapy or for that matter, any movement whatsoever. Apparently that's what she didn't do--move (or so I've been told by a friend). Now she's scheduled for a joint replacement having never been offered the option of physical therapy. I cannot help but think her inactivity accelerated her joint problem.[2]
• I encourage my patients with knee and hip pain to exercise and especially to lose weight. If I send them to an orthopedist they come back to me and deny that the orthopedist recommended weight loss. I think they just didn't hear what they don't want to hear but many times, there is nothing in the referral note indicating that they were told to lose weight. 
• Last week two patients came to me after they saw their orthopedic surgeons asking ME to send them to physical therapy. Why? Because the surgeon didn't recommend it. 

Several years ago a friend of mine was sitting in an orthopedist office. After looking around the orthopedic's waiting room, she began a diet and exercise program the next morning. She told me "Except for the athletes, every person over 50 in that office was at least 30 pounds overweight. How can you miss the message there?" At that time she was in her early forties. Now ten years later she has kept the 10 pounds she shed off and exercises at least four times weekly.

Day in and day out I understand how frustrating it is to try to motivate patients to exercise and lose weight. Many of my orthopedic colleagues DO emphasize these things and my sense is that they are improving in that regard. In a society where obesity is ever more the norm, we've all got to be on the same page to help patients make changes, especially if you are the expert in the patient's eyes.[3] 

1. http://well.blogs.nytimes.com/2013/07/11/doctors-badmouthing-other-doctors/

2. http://www.mayoclinic.com/health/arthritis/AR00009
3. http://www.news-medical.net/news/20130411/Orthopaedic-surgeons-should-recommend-weight-loss-to-patients-prior-to-joint-replacement.aspx

A Personal Moment

Rarely do I take two week vacations, but my adult daughters have begun their own lives, very separate from mine. This was the last chance to take one together so my husband and I indulged. Tickets were bought last September. My mother, at 84, was doing well enough though she showed signs of some memory loss.

As her memory loss became more apparent, we decided it was time for a retirement community. I began the process and as luck would have it, my vacation fell smack in the middle of planning her move, trying to sell her condo and all the attendant details involved in that. She fell apart.

Weeks before I left she began calling me five to twelve times a day. She couldn't remember decisions we'd already made. She changed her mind a million times. Finally, I flew away for the first week of my break leaving my husband in charge of dealing with her for the first week. He did well but there was no one to help during the next week when all four members of the family were in another country.

So two weeks later, I return to find this horribly diminished individual. She looked like she had lost weight and she repeated herself over and over and over until it was all one can do to keep from screaming "STOP". I seriously thought that we needed to change from a retirement home to an assisted living facility. Then the oddest thing happened. Thursday night the real estate agent called. She had a buyer for my mom's condo. I gave a verbal OK, then cringed at the reality of convincing my mother. The next morning my husband and daughter went to oversee my mother's signing of the papers. She did it, then my husband spent the day with her, feeding her twice. On Saturday I spent the evening with her and she accompanied me while I helped my daughter unload boxes into her apartment. While my mom couldn't do that, she sat next to the car while three of us shlepped the boxes which really helped get the unloading done faster. Then she came into the kitchen and unwrapped dishes. When she returned home my daughter called to thank her for helping. I fed her again. On Sunday I returned to help her with some financial questions regarding the move. This time she looked at me and said "You know I'm starting to think this move is a good idea. I'm even looking forward to it a little. By the way, I called people multiple times while you were gone, didn't I? I have no memory of that. It's like I've been in a fog. I think I went a little kooky. Could I have had a stroke? You've been working very hard for me, come on and I'll buy you dinner." 

I was amazed. Suddenly she was remembering stuff she did five and ten minutes before. She had insight. What happened?? How was it that I had my mother back? She still has trouble remembering but she's not the diminished lost woman I came home to. Was it just eating properly? I know she hasn't been eating during these stressful weeks and we had fed her well for an entire weekend. Was it the socialization? She'd been interacting with people all weekend. Was it honestly being helpful to someone? I have no idea. What I do know is that pseudodementia is complicating an underlying mild dementia that she refuses to take medication to treat.  

At any rate, my belief it that moving her to an environment with exercise and social stimulation will improve her mentation. Maybe she'll have quite a few years in her new home where socialization, activities and getting to know your neighbor is the norm. 

Doctors 2.0 - Second Post

Sitting next to +Ronan Kavanagh in a nice French restaurant after the first day of the Doctors 2.0 conference, he commented, in his lovely Irish brogue, "You know, at our age we are not supposed to have the opportunity to make so many new friends. But look at this table, all brought together by a common bond." 

What great fortune, to be sharing dinner with six interesting people who I'd had the fortune to meet on Twitter during the last year. The cool thing was--they were every bit as awesome IRL (in real life) as they are on line. All of us share a passion for making the patient experience better using digital tools--gamification, the quantified self, video patient information, social media for physicians and patients, etc. And while I didn't meet John Brownlee on Twitter, he was the other common bond amongst us; the CEO and founder of ClearMD who organized the meal.

The Doctors 2.0 conference brought doctors, patients and entrepreneurs together in an incredible setting, la Cité Universitaire:

We heard from healthcare startups, e-patients, pharma, doctors and medical futurists among others while networking and eating French snacks. Maybe it was the wine, but when the two day conference was over, I was left with a hopeful feeling that patients, doctors and healthcare entities who put patients first can brainstorm and make a difference for the better in patient lives.