Janet and her siblings live in Ohio, where they grew up. Her parents retired more than a decade ago to Arizona, and her dad died two years ago. Mom Beth is independent, strong of mind and spirit, and in generally good physical health, except for the arthritis in her knees that forced her to give up Pilates for a mild form of yoga. She also suffers from an allergy to certain environmental toxins that even the dry desert air can't defeat. She takes a combination of medications prescribed by her physician as well as vitamins and herbal supplements recommended by other women in her bridge club.
Early this spring Beth developed a nasty cough that no over-the-counter medicine could cure. Either the cough itself or whatever bug was causing it so depleted Beth's energy that she lost her appetite and could barely drag herself to the doctor's office. Like many older parents, Beth didn't want to worry her adult children, who, after all, had their own lives to live, so she nimbly dodged her daughter's questions about her health in their nightly phone conversations.
The doctor ordered a chest X-ray that showed no signs of pneumonia or other serious conditions. He then prescribed a cough medication that after a week had failed to make Beth better. By then, she was too weary to drive back to the doctor, so he prescribed something else over the phone. She swallowed her pride and asked her next-door neighbor to take her to the local drug store to pick it up. But no prescription had been faxed from Beth's doctor. The pharmacist called the physician, and got a voice message that the office was closed and suggesting a visit to the nearest emergency department if the caller thought the problem was serious enough to warrant it. Beth went home empty-handed.
During the night, Beth's cough became so severe that she began to spit blood and had a difficult time breathing. In a panic, she called her neighbor, who drove her to the nearest ED. The young doctor on call told Beth she had a common viral infection that had been making the rounds. It was not normally a big deal but had gotten so bad in Beth's case she would have to be admitted overnight.
The hospital contacted Janet in Ohio, who flew to Arizona in a state of alarm. Beth was discharged the next day, handed another prescription and told to check back with her doctor within the week. What they did not tell her — or what Beth does not remember them telling her — is that the medicine for her infection might interact badly with the other prescription and herbal medications she was taking. If the pharmacy had any advice to offer on the subject of drug interaction, it did so only in the typed instructions stapled to the bag with the pill container — which Beth crumpled up unread and tossed in the trash as soon as she got home.
You can probably guess what happened next. Beth had a horrible reaction to her meds and within a couple of days wound up back in the emergency department. She then had to be readmitted to the hospital for something far worse than her original diagnosis, where she spent three days before she was able to be discharged with a prescription for yet another medication.
This time, a nurse sat down with Beth and Janet and carefully went over the discharge instructions, asking Beth to repeat exactly what they had just been told. But nobody made follow-up phone calls, which are now routine at many hospitals, and no one dropped by Beth's townhouse for a face-to-face visit. Fortunately, the new meds worked and Beth is well on her way to a full recovery.
You might ask why this matters to anybody but Beth and her family. What does one woman's bad luck or carelessness have to do with the rest us?
Other than the fact that Beth is by all accounts a good and decent fellow member of our human race, it matters because there are hundreds of thousands of other Beths out there, and as the baby boomers push into senior citizenhood, there will be millions more. People who want to live in their own homes, often alone, who might be far from loved ones, who put off care, and when they finally do get it, fail — out of ignorance or forgetfulness or tight finances or sheer mule-headedness — to follow through on what their doctors tell them. They end up sicker than they needed to be and use up a much bigger share of health care resources than they should have.
It is tempting to pity the individuals' fate or blame them for their failures, but that won't solve the expensive problem of treating them for avoidable ailments. It is far less costly for the health care system to provide coordinated care that includes, among other things, better communication among everyone involved, better discharge planning and instructions that the patient clearly understands, and better follow-up after each and every step of a patient's care.
Agree or disagree? I'd like to know your thoughts on this issue. Email me at firstname.lastname@example.org.