Chronic condition care

Many of our patients live with more than one chronic illness. Several live with five or more, on a dozen medications, seeing four specialists who don’t talk to each other. That situation is not an edge case here. It’s the practice.

• Type 2 diabetes, including insulin management
• High blood pressure, high cholesterol, heart failure, and coronary artery disease
• COPD, asthma, and chronic respiratory conditions
• Chronic kidney disease
• Thyroid and endocrine disorders
• Osteoporosis and arthritis
• Obesity and metabolic conditions
• Cognitive decline and dementia
• Depression and anxiety as they interact with chronic illness

Chronic conditions don’t hold still, so the care can’t either. Between visits, your physician is reviewing labs as they come in, adjusting medications when numbers move, and reading the specialist reports that arrive in your chart. At your appointments, there’s time to work through all of it rather than triaging to the loudest problem. Thirty minutes minimum, longer when the situation calls for it. Family members are welcome and often helpful. And nothing is left hanging at the end of the day. Before this office closes, every prescription has been called in and every patient who called has been called back.

When you see four specialists, someone has to hold the thread. Usually that’s the patient, or an adult child with a folder of paperwork. Here, it’s your physician. We make the referrals, send the records ahead, chase down the reports, handle prior authorizations, and reconcile every medication change any specialist makes. When two recommendations conflict — and they do — we sort it out before it becomes your problem.

Your physician will systematically review every medication you’re currently taking and determine which ones you still need, which you don’t, and which might be best to replace with something else. It’s a comprehensive process, which includes:

• Blood work and an examination to check for nutritional deficiencies and underlying conditions before changing anything — sometimes what looks like a medication problem is a thyroid problem, or a B12 deficiency, or dehydration.
• A full inventory: every prescription, every supplement, every over-the-counter product.
• Deprescribing where it’s warranted. Medications that no longer help, that duplicate each other, or that are causing more harm than benefit come off, safely and with monitoring.
• Substitution and combination where it helps. Sometimes a different drug does the same job with fewer side effects. Sometimes two lower doses work better together than one high one.
• Ongoing monitoring. Medication management isn’t a single appointment. Labs get checked, doses get adjusted, and every change any specialist makes gets reconciled against the rest of your list.

Same-day or next-day appointments when you’re sick. Same-day prescription refills. A live person answering the phone, every time. And after hours, on weekends and holidays, you can call and speak directly with a physician. For someone managing a serious chronic illness, that access is the difference between a phone call and an emergency room visit.