Doctor-Patient Partnership: Patients of Advanced Age Use Medical Diaries to Improve Coordination of Care

By Barber, Ann | Care Management Journals, December 1, 2010 | Go to article overview

Doctor-Patient Partnership: Patients of Advanced Age Use Medical Diaries to Improve Coordination of Care


Barber, Ann, Care Management Journals


Coordination of care suffers when patients are treated by multiple physicians who do not communicate with each other. Medicare patients see about five different physicians a year, and patients with heart failure or diabetes see on average 13 physicians annually. The Institute of Medicine (2006) also notes that Medicare pays providers for the number of patients served rather than patient outcomes or coordination of care. Thus, few health care professionals have the time to volunteer for care coordination.

If patients of advanced age are the first to realize their symptoms, then they are in the best position to coordinate their own health care. Some such patients may designate a family member or caretaker to serve this role, but many find taking on this responsibility for themselves both empowering and rewarding.

To collect data and to communicate these data to health care providers, we propose that patients keep medical diaries. These are designed to summarize symptoms, test results, diagnoses, treatments, outcomes, and follow-ups. This proposal is based on the hypothesis that patients of advanced age record their test results in a timely way and communicate these data to their health care providers regularly. For patients, we assume that the diaries help them see the cause and effects of unhealthy behaviors. For instance, they may notice decreased blood pressure when they stop shaking salt on their food. Or their body weight may decrease when they omit sweets from their meals. We notice that such observations motivate patients to adopt healthy habits. As for families and caretakers, medical diaries bring them up to date with patients' symptoms, medications, and doctor appointments. In this way, family and caretakers help patients avoid duplicate testing and overmedication.

Patients like to customize their medical diaries according to their personal tastes. In addition, we teach them that the following sections in the diary are useful to health care providers (see Appendix A): calendar of doctor appointments; chief concerns; diagnoses; medications and allergies; vaccinations; operations; dietary preferences; tobacco, alcohol, and drug dependence; exercise; healthcare proxy; advanced directives; medical policy statement; blood pressures; body weights; respiratory rates; temperature; teeth; mood; and test results. In this way, we teach patients to focus their efforts on tracking measures proven to save lives and improve health. For instance, we designed medical diaries to focus on evidence-based improvements in medication adherence, hepatitis vaccines, diabetes, substance abuse, inactivity, hypertension, obesity, hypercholesterolemia, HIV infection, depression, and cancer screening with Pap smears and colonoscopy (Farley, 2009).

Critical questions about medical diaries are as follows:

1. Are the data recorded by patients true?

2. Is it fair to ask patients of advanced age to maintain diaries and coordinate their own health care?

3. Will medical diaries build goodwill and improve doctor- patient relationships?

4. Will the medical diary benefit all concerned, including the patient's family and home health aides?

To address these questions and to illustrate how medical diaries improve patient care, let's consider four patient scenarios.

Question 1. Are the data recorded by patients true?

Case 1. " I am a 95-year-old man with hypertension. On Thursday, 11/5, I didn't take my blood pressure pill because I was out of town. The next day at noon when I returned home, I took my pill. Then, on Saturday 11/7, while running to catch a bus, I felt chest discomfort for 1 minute that stopped as soon as I stepped onto the bus. On Sunday, 11/8, I took my BP pill at 7 a.m., but while walking up the hill to church, I had trouble breathing. However, as soon as I stand still I can breathe again."

Such casual observations and concerns are often omitted during the physician's interview because the patient feels that these symptoms are not important and the physician seems too busy. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Doctor-Patient Partnership: Patients of Advanced Age Use Medical Diaries to Improve Coordination of Care
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.