Informed Magazine - Winter 2009.pdf - Parma Community General ...

care to keep patients well
family, and watch how parents and kids
interact, you develop a rapport and a
comfort level with each family member,”
said Dr. Saridakis.
Selecting specialists
PCPs also help guide their patients
through the health care system by
selecting specialists to manage aspects
of their care, such as cardiology or
orthopedics, when necessary.
Each PCP has specialists they prefer
to handle the care of their patients.
“You want the A-team on your case
at all times,” said Dr. Loyke, noting that
he looks for clinical excellence as well
as compassionate care and an ability to
communicate with other physicians in
coordinating care for the benefit of the
patient.
Patients have a major advantage
when they see physicians with privileges
at a community hospital: doctors
are better able to keep in touch with
each other and follow through on the
patient’s care, said Dr. Saridakis.
A primary care physician can coordinate
the care in complex cases, especially
for older patients. For example,
the Acute Rehabilitation Center provides
additional therapies to strengthen
patients before discharge. Keeping
patients onsite allows their PCPs to follow
their care more closely, said William
Crowe, MD.
For example, an 85-year-old
woman who lives independently but
breaks a hip or develops pneumonia has
a better chance of returning home again
with the aid of rehabilitation onsite.
“A finely balanced situation can be
lost,” Dr. Crowe said. “Inpatient rehabilitation
here at Parma Hospital gives
us more breathing room to help patients
return home rather than going to a
nursing home.”
Nurse practitioners are
registered nurses with
additional training who
complement primary
care physicians, seeing
patients in the office
and in some cases at
the hospital. Nurse practitioner
Donna Vale, left,
is a certified diabetic
educator who serves as
a resource for doctors
like Jennifer Wurst, MD.
These advanced practice
nurses are primary
health care providers,
with emphasis on teaching
and prevention.
Minimize trips to the Emergency Room
Having a regular primary care physician
(PCP) can eliminate unnecessary
and costly tests that may be ordered in an
ER when a physician is less familiar with
a patient, says Timothy Gallagher, MD.
It can also save patients time. Most
PCPs are available in the office daily for
sick visits as well as well visits.
“A lot of time people are seen in the
ER for something that maybe five days
sooner could have been taken care of in
the office and not required an ER visit,”
said Jason Sustersic, DO. “The theory of
primary care is: if someone calls in sick,
they should be able to be seen that day,
or at least the next day.”
Persistent coughs, back pain and
sinus issues may better be handled in
the physician’s office, while symptoms
such as active wheezing, shortness of
breath or dehydration can better be
served in a visit to the ER for immediate
care, Dr. Sustersic said.
“We are going to try to keep you out
of the hospital and out of the ER,” Dr.
Sustersic said.
Managing complex
situations for elderly
The global perspective offered by a primary care
physician becomes even more critical for older
patients.
William Crowe, MD,
an internal medicine
physician with a special
certification in geriatrics,
notes that many patients
may take a dozen
different medications,
covering half a dozen
William Crowe, MD diagnoses.
Dr. Crowe recalled a patient he saw in the
office who was on multiple medications for
diabetes and high blood pressure. But the man
also suffered from lower extremity edema,
severe swelling caused by a build-up of fluids
in the skin and organs. Two of the medicines
he had been prescribed by other doctors were
making his edema worse. Dr. Crowe switched
his medicines and the man shed 30 pounds of
water weight.
“We review the medication record every time
a new medicine is added, or a new problem
develops,” Dr. Crowe said. “That drill goes on
again and again, and it should.”
Geriatric care actually begins around age 75,
Dr. Crowe explains, yet it’s the physiologic age
rather than the chronological age of the patient
that really matters. In addition to reviewing a
patient’s medical history with each visit, PCPs
focus on preventative issues such as screenings.
In older patients, the issue becomes when to
cease screenings.
By the age of 75 or 80, many doctors, at the recommendation
of health agencies, no longer push
for screenings. One exception is osteoporosis.
“You can intervene even in the very old for
osteoporosis,” Dr. Crowe said.
PCPs – especially those at Parma Hospital who
manage their patients even while they’re in the
hospital – offer a continuity of care that benefits
patients, Dr. Crowe said.
And for older patients eventually facing end-oflife
issues, the relationship formed with a PCP
can be comforting.
“All you need to do is see the looks on their
faces,” Dr. Crowe said. “They’re relieved and
happy to see me. It truly makes their care more
efficient, to know that I’m there for them every
day. We don’t have as many problems with endof-life
care, because people know us.
“If I’ve been their doctor, they trust me and I
am straightforward with them. It’s so much
easier to go through this with them if we have a
relationship.”
Winter 2009 Informed 5