In a recent doctor’s appointment with a client, I learned her liver enzymes were elevated. The doctor seeing her is a hematologist. He ordered a few tests as the client’s chief complaint was extreme fatigue. Once the labs were back, he looked over her medications and found that one of the drugs could cause elevated liver enzymes.

During the visit, the doctor explained to the patient and me how elevated liver enzymes could cause extreme fatigue. He recommended that she come off one of her meds thought to cause the problem. I asked the hematologist if he would call the cardiologist and explain what he was seeing and discuss some of the options.

The doctor said, no, the patient has to do this. He said we are all specialist; and we don’t tell each other how to practice.

This encounter made me think: have we realy made any progress in improving communication? Is the theory of care coordination only in textbooks?

I recommended to the patient that we see her cardiologist, bring the lab work, and other tests performed to evaluate her complaint of fatigue to see what he says. The patient agreed, so I made the appointment and prepared for the appointment by asking the patient to talk to her two sons to ensure all were in agreement. The patient and her two sons had a call to discuss the situation. On the call, the patient explained that being so tired was impacting her quality of life. She understood she was on the medication due to her heart condition. But she was willing to take the risk and stop the drug if it was responsible for causing her fatigue. The sons agreed and asked me to explain this to the doctor.

On the date of the appointment, I accompanied the patient to the cardiologist office. The doctor came in and asked the patient how she was doing. She explained to the doctor, she was extremely tired despite sleeping well. She also was having tremors that were impacting her ability to do simple things. He reviewed her lab work and her mediation. He said she needed to be on all of these meds to help prevent a heart attack. The patient explained that she was tired and could not stand living like this. She said her son told her that a few of her medications could be causing/adding to the fatigue. She asked if she could come off the medication in question to see if it helped. The doctor re-evaluated the reports and said ok, lets stop a few of your medications to see if it helped. He said he would see her in two weeks and to go to the ED if she had any chest pain.

I was proud of the patient as she talked to the doctor. She advocated for herself and helped the doctor see that even though the protocol calls for a specific plan of care, the patient side effects warrented a re-look at the plan of care.

The patient is medically complex. Having four different doctors manage her care is challenging. As the Nurse Advocate, my job is to listen, use critical thinking, and work to keep each doctor informed by bringing to their attention problems that arise so they can make decisions.   My role is also to empower the patient to speak up when something is not right in their view.  I feel like I did this as best I could.

Thanks for reading this Blog Post. Please put a comment in the below if you have had an experience like this and tell us how you handle it!

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