Y'know.How important is scope of practice?I spoke to an elderly patient of mine. Her husband is on many chronic medications. So is she. Her doctor has recently retired. She is worried that, because she doesn’t have a doctor, her 90-year-old husband will not be able to get the medications he needs to treat his bad heart and high blood pressure (she is less worried about herself – that always impresses me). She was told that no doctors want patients like her and her husband because they are complicated and need lots of work. She said she lies awake at night worried that she won’t be able to get the medications that are helping keep her husband alive or avoiding a stroke or heart attack.Of course, I told her we wouldn’t let that happen. She was relieved, and left thanking me profusely.I know I could do more to help her, if I was allowed to. If we are keeping his blood pressure at target, I could do that. His cholesterol monitoring – including liver blood tests – why not? And evaluating all of his medications to ensure he is getting the best benefit – I believe I was well trained to do that. And referring him when things appear to be getting worse – well, I do that already.And then maybe those doctors who don’t want complex patients wouldn’t have to do so much work to manage those patients.And then maybe a nice lady could get a peaceful nights sleep.
