With thanks to Charles Dickens and his 1859 novel, “It was the best of times, it was the worst of times.”  Surely, his words could be applied to our country’s healthcare system.  But never was it so apparent (this week) that patients need advocates as it was when I interacted with two case managers, on behalf of the same patient, in two cities and obviously, in two hospitals.

Meet Julie (not her real name), a former critical care nurse who transitioned to case management at her community hospital this year because she needed a change.  Terry (not her real name either) has been a case manager for many years and works at a large academic tertiary care medical center. 

Our patient had been transferred to the large medical center on Saturday to receive a higher level of care after her stay at the community hospital.  Julie, the newer case manager, had done an extraordinary job of collaborating with us to facilitate the transfer and signed off late on Friday with her best wishes to the patient.

When I called on Monday to speak with Terry, the case manager at the larger facility, it was to introduce myself, get her up-to-speed on the patient’s case and to ask her to visit the patient’s room.  She wasn’t yet familiar with our patient so I filled her in on her initial diagnosis and her recent admission.  I also explained that the patient’s mom was worried because she had just been told her daughter had pancreatitis.   I continued and said, “I was just hoping you could go down to her room and maybe meet with the patient and her mom.  They’re a little worried about the pancreatitis diagnosis and it might be helpful if you could explain to them what it is, etc.”  Her response?  “That’s out of the scope of my practice.”  Wow, I thought.  I’m asking you to talk to your patient and you’re telling me it’s out of the scope of your practice? 

I held my sarcasm and presented to her that it would really be helpful if she could visit the room and perhaps invite one of the medical residents on the patient’s case to join her.  She eventually agreed and we hung up.  Later, mom called to tell me that Terry had come down asking “why does that nurse want to know so much information?”  Nice work, Terry.

Later that day, Julie called “just to check in to see how my former patient is doing.”  I chuckled as she asked and I thought to myself, “What a difference from one hospital to the other.”  Here is this NEW case manager calling to check on her former patient and I can’t even get the current, 'seasoned' case manager to visit the patient’s room!

And so goes our healthcare system where your experience and care can be so vastly different thanks to one healthcare professional.