I wish my doctors talked with each other.

Not all of them, just the main ones:  My two oncologists, my primary care physician, and my nephrologist.  Those are the doctors that I see regularly.

Sometimes they send each other their notes from my most recent visit, although I’m not sure this happens efficiently all the time.  On top of that, I suspect that these office visit notes don’t get read until I pop up in the queue for an appointment with one of those doctors.  That could be weeks, even months later.

What got me going on this subject was a recent blip in my blood work related to my kidney function.  In talking about this with one of my doctors, I said that I had discussed this with my nephrologist.  The response I got was:  “You have a nephrologist?  How often do you see him?”

That comment wasn’t as bad as it might seem.  Since my initial diagnosis, I have had transitions from one doctor to another either because I was forced to change because of circumstances or because I chose to make such a change.  Things like that can wreak havoc on continuity.

What bothered me more, I think, was that my nephrologist’s take on what was causing the problem was considerably different than what the other doctors thought.  It was left to me to communicate this.

Don’t get the wrong idea.  This isn’t a criticism of any of my doctors.  I think they all are excellent.  But they all carry heavy caseloads, and they are extremely pressed for time because of that.

That’s the rub.  Each is focused, often narrowly, on what he or she is doing for me and how those things are working out.  Little time, if any, is spent on what the other doctors are up to.

So that leaves the communication across doctor lines to little ol’ me.

One difference is that I am my only patient.  So, I think I’m pretty competent in filling in each doctor with the latest developments among those in this small group.  I’m comfortable doing this but should it be my job to make sure all my physicians are on the same page?

What I’m talking about is something called “care coordination,” which is all the rage in health care right now as the field looks for ways to be more efficient and less costly, with fewer mistakes.

I may have mixed feelings about “coordination” because I worry that the underlying motivation is to save money, and I’m concerned that it could sometimes usurp the best judgment of my doctors.  I trust myself to know more about what’s going on in my treatment, as well as with the rest of me.

Right now, however, it’s my job to tell the right hand what the left hand is doing.

There are times when I am out of sorts and I’m not particularly capable of making sure that we aren’t just treating the latest difficulty in a vacuum.  This is where Linda, my wife, has to step in and take over.

In the aftermath, she and I are the ones left to relate and share information with my various doctors about any particular health problem I’ve encountered and how it was resolved.

I’m not sure this is how it should be.

Perhaps I would like there to be one person in this loosely knit health care team of mine who would be responsible for knowing exactly what is happening with me across all those doctor lines.  And I hope it would be a medical professional, not a bean counter.  I don’t want this person to take over my treatment and the rest of my health care.  I’d like for him or her to monitor it and direct it, and bring my doctors together. 

Most importantly, I want to be a partner in this coordination process.  There are times when the decision on what to do next is mine, and I don’t want to lose that.

I know there are many people who follow the dictates of their doctors.  That certainly is okay for them, but not for all of us who are extremely involved in the course of our treatment and all that’s related to it.

Really, I’m not certain how we resolve this.  I do feel that it’s not enough that the only time my various doctors hear from each other is through notes sent through the mail.

Wishing for something more than that may be pie in the sky.

Nonetheless, the fact remains that my doctors don’t talk with one another.