The Antidote to Fragmented Health Care

When Dottie Phillips, the healthy 85-year-old mother-in-law of one of us (Amy), broke her elbow, the orthopedist did a wonderful job surgically repairing the injury. Unfortunately, Dottie developed pneumonia in the hospital during her recovery, requiring powerful antibiotics. These led to a subsequent Clostridium difficile (C. diff) infection, which produced debilitating diarrhea. Her prolonged hospital stay caused her to become frail, so she was discharged to a rehab facility with an entirely new care team. A month later she was back home and her care was taken over by her regular doctor, who had little contact with either the hospital or rehab facility.

The people responsible for knitting together and communicating the complete picture were Dottie’s husband as well as her son (Amy’s husband), who lived 2,000 miles away. Her husband tried to relay everything that happened during both stays to her family doctor, but the care was complex and her husband had been afraid to bother the doctors by asking too many questions. Her son, who had power of attorney for her medical care, flew in whenever the next catastrophe occurred.

Using a walker with a broken elbow to get around her home was beyond Dottie’s newly diminished capacity, and she fell, which resulted in a painful compression fracture of her spine. At her follow-up visit, her primary care doctor heard her cough, saw an abnormality on her chest X-ray (both expected after a recent bout of pneumonia), and treated her with antibiotics, thinking it was better to be safe than sorry. They rapidly led to a recurrent C. diff infection. Dottie went back into the hospital suffering from severe back pain and diarrhea and died a short time later.

All the clinicians involved in Dottie’s care did exactly the right things to treat the individual problems they were trained to treat: broken bones, infections, and poor mobility. But they failed to serve Dottie’s collective needs.