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DISCIPLINE: Interdisciplinary

Surgery and Delirium

From Mark Orringer, MD, past president of the Thoracic Surgery Directors Association, who challenged the organization to increase the extent to which geriatrics issues are addressed during residents’ training. A few years ago, I operated on the 80-plus year old father of a colleague. He had problems with his esophagus. The operative time was short, and the procedure went well. But after surgery, the patient was confused and put into restraints ‘to protect him.’ While restrained, he aspirated and ultimately died of pneumonia. Retrospectively, we missed the mark badly. There’s not a thoracic surgeon who hasn’t mismanaged delirium, because we have not been trained to recognize it and respond with appropriate measures.”

Excerpted from the John A. Hartford Foundation 1999 Annual Report

The Health care Maze

Barbara’s father, George, age 90, sent home from a Florida hospital after a bout with pneumonia, was not doing well. He complained of being unable to sleep, had trouble walking, and his mind was beginning to wander. His wife, age 88, called their local internist, who prescribed a sleeping pill. He also suggested she contact a physical therapist from the hospital to assist her husband in regaining his strength, but when the therapist arrived, George was too groggy to do any exercise. Barbara’s mother, overwhelmed, called her daughter, who lived in Pennsylvania, and urged her to come down to Florida to help get her father back on his feet. When Barbara arrived, she was shocked to discover that both of her parents had lost a great deal of weight because they weren’t eating properly, and that her father was self-medicating, taking more sleeping pills than prescribed because the initial dosage had not done the trick. Worst of all, the household was deteriorating and no one—neither their primary physician nor anyone from the hospital—seemed to be aware of her parents’ failing condition or in charge of coordinating the multiple healthcare and social services they now required.

Excerpted from the John A. Hartford Foundation 2000 Annual Report

The GITT Approach from a Doctor’s Perspective
Lisa Davidson, MD

When you are seeing someone in your office, you have all the control…but when you do home visits, you really see the problems that people are facing. It’s one thing to tell your patient to take your medicine and you need to be on a better diet, but when you see that they’re stuck in their apartment and don’t have anyone to get their prescription for them or that they are not eating because there is no food in the home, it’s a completely different experience. It makes you realize that maybe what we focus on in medicine and the things that are important to us are really not the things that are important to our patients. It has changed the way that I interact with patients. It’s more important to find out about them as a person than as a disease. Long-term disease only defines a small part of their life. The team approach (GITT) worked really well. We talked about issues we are not really trained to pick up on, ethical issues, family support. In fact, one of the things that most impressed me about this program was the amount of enthusiasm from team members and their ability to find ways to help patients.

Excerpted from the John A. Hartford Foundation 2000 Annual Report

The GITT Approach from a Nursing Perspective
Lillian Flores-Perez, RN, MSN, NP-C

In observing the interaction of a GITT team, Flores-Perez understood how a nurse-practitioner can utilize both the medical insights of the physician and the social insights of the social worker, Before, those two perspectives often seemed in conflict. “I could see that patients under the age of 80 primarily need medical management. We need to make sure that we control the blood pressure and the diabetes and all those needs so they won’t have long-term negative consequences. But then I was able to see that after 80, the primary goal is to make sure that all of their psycho-social needs are cared for. Solely medical management is no longer a priority. So that’s when the light bulb went on. And once I learned how this type of team care is crucial for helping the patient, I was able to immediately implement it in my current job.”

Excerpted from the John A. Hartford Foundation 2000 Annual Report

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