Global Personal Medical Case Management The Advantages of Personal Case Management

February 2010
The Advantages of Personal Case Management
"In an era when the time allocated to each patient, even in the realm of private medicine, is limited; an era in which medicine has become so complex and sophisticated, personal case management offers a superior quality solution to patients suffering from complex or severe ailments."
Professor Menachem Fainaru 
In years past, one physician was all you needed for all of your medical needs. In that era, the typical physician had both the knowledge and skills in all available areas of medicine. He was your obstetrician, your surgeon, and your phlebotomist.
Technological developments and advances in medical research have brought about a division in the field of medicine. The complexity and sophistication of today’s diagnostic options, invasive procedures, surgeries and treatments have rendered it impossible for one physician to know everything in all medical fields.  The result has been the establishment of specialization and sub-specialization in most medical fields.
Take for example, the practice of ophthalmology: there are lens specialists (cataract surgery); cornea specialists (correction of myopia); specialists in retinal diseases; etc. Each of these subspecialties is a world unto itself, with its own set of knowledge, skills, expertise, medical conventions and more.
On the one hand, this diversification is a blessing. The knowledge, skills and expertise we gain intensifies and advances the field of medicine. On the other hand, it now takes a doctor about twenty years to become a highly skilled specialist in a given field. Naturally, at that level, the physician's time is very expensive as he would like to receive payment commensurate with his skills and achievements.
A patient who pays a small fortune for a private appointment with a specialist expects to receive the doctor's full attention and as much time as they need. The physician, however, cannot afford to linger. He or she is not interested in wasting time on lengthy explanations or on an in depth examination of the patient’s medical file, especially if it’s lengthy. Additionally, today's highly specialized medical expert “knows everything about almost nothing.” Areas of specialization are so refined that the one and only solution an expert can suggest relates only to the one field in which he or she has the specialized and extensive knowledge.
Take for example, a woman suffering from uterine fibroids (myoma) in her uterus. There are numerous treatment options, both invasive and non-invasive. Among the options are laparoscopy through a stomach wall approach or via the vagina; embolisation and ultrasound therapy to name a few. If the patient were to consult a surgical specialist, she would most likely be advised to undergo surgery, either because the specialist truly believes that this is the best alternative, or because it is the most profitable alternative for this particular specialist. In the best case scenario, the patient would be informed of the various alternatives available to her. The strongest recommendation would almost certainly be to seek surgical treatment. In the worst case scenario, the patient would not be advised of the possibility of less invasive procedures.
An additional example: You suffer from impaired vision and are sent to an eye doctor. The doctor focuses only on your eyes as this is his relevant area of expertise. Let's say in this case that he diagnoses a cataract and sends you to a lens specialist for surgery. You have the operation and it is a success, with no complications and no side effects. Yet, you have one small problem. You still can’t see very well.
What went wrong? The physician who specializes in cataract surgery does not always see the whole picture and generally does not investigate possibilities that are out of his field of expertise.  Poor vision can be the result of various problems, not all of them directly related to the eyes itself. Diabetes is one such example. So who should be looking at the whole picture and guiding this patient? It is the job of the General Practitioner (GP). The GP is expected to know that untreated diabetes can lead to impaired vision. It is the GP’s responsibility to alert the eye specialist that this might be a possible cause and that surgery should be postponed until the diabetes has been brought under control. Only if there is then no perceptible improvement, should surgery be considered. The problem is that here too, economic interests may enter the picture.
How much time does the general practitioner allocate per visit? The average consult with the GP is scheduled to last between 7 and 10 minutes. This is due to the large number of patients doctors see each day. If a physician does not fill his daily quota, he will earn less. This results in the physician “working hard” to free up the chair for the next patient. This often means devoting as little effort and thought as possible in order to minimize the amount of time spent on a single appointment. “You're not seeing very well? Here’s a referral to the eye doctor.” “You have a headache? Here's a referral to the neurologist.” And so on.
This situation is also prevalent in internal medicine wards where, the internist functions as the “GP” of hospitals. On average, a typical patient spends four days in the internal medicine ward. This is not enough time to carry out a comprehensive, in depth investigation into the patient’s complaints and symptoms. The physician on these wards does not have the opportunity to follow up on the case once the patient has left the hospital because the HMOs refrain from approving payment for follow-up visits at the hospital.
It is precisely this gap that the personal case management service of Medix is designed to fill. Personal physicians at Medix are senior internists, physicians with a wide range of knowledge and an integrated vision, capable of understanding and communicating with the specialists in their own language.
Personal case management has several virtues which give it an advantage over HMOs or private medicine:
More Time
Your medical case manager is yours alone. This physician has no other patients waiting for his time. He or she will thoroughly research every document in your medical file. After your case manager is familiarised with your case, he or she will then schedule a phone call with you to discuss your case in a calm and unhurried manner. During this call, you will be given all of the information pertinent to your case in a clear and understandable fashion. Your case manager will also suggest a range of alternative approaches and provide referrals to the most suitable specialists.
Knowing Who To Consult
Today’s patients who try to garner information via the internet quickly lose their bearings in the vast sea of possibilities. Your case manager will ensure that you reach the most suitable physician, the one with the most experience and with a proven record of practical success in exactly the discipline you require. If necessary, in cases where a sufficiently experienced specialist is not available in your country, the facilitator will aid in reaching the best experts abroad.
Independence and Objectivity
The case manager has no bias towards any doctor, HMO or hospital, or towards any particular kind of treatment. Your case manager’s decisions and recommendations are independently formulated, tailored to the specifics of the case under consideration and under no financial pressure to prefer one particular physician or treatment over another.
Long Term Support
The case manager oversees the patient’s care from the assessment stage, throughout the treatment and the recovery stages, at the hospital and at home. The manager’s responsibility goes beyond providing one-time advice or a referral to a specialist; rather, this professional maintains constant contact with the patient, advises on necessary tests, aids in understanding test results, explains the various options available, refers to the best specialist available, analyses recommendations, prepares a summary report, and also provides emotional support.
In summary, personal case management is an essential medical service. It's purpose is to address the needs of patients with complex medical cases, who often feel confused, helpless and overwhelmed by the demands of their situation.
We live in era when the time allocated for each patient is so limited, an era in which medical care is so complex and offers a plethora of choices. The service offered by Medix returns the reins of medical case management from the patient who is overwhelmed to those who understand the world of medicine all the while making sure that the patient and his interests are at centre stage.
Professor Fainaru is a highly regarded and experienced internal medicine specialist and a member of the Medix Scientific Committee.


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