Difference Between Providing Care and Managing Care: Arlene H’s Story

I am a retired nurse clinical specialist with over 50 years of experience in health care including three years teaching at the College of Nursing at U of I Chicago. I was part of many exciting and challenging treatment programs prior to the transition into the era of Managed Care. I hired and trained staff and I developed and directed programs of care. I know the difference between providing care and managing care.

Prior to my recent 1 1/2 to 2-year search for help with my knee pain and mobility problems, my health care needs were minimal. My experience prior to coming to IBJI was emotionally and mentally draining, and puzzling—since I have excellent insurance coverage.

To illustrate: In scenario #1, I made an appointment with a primary care physician to begin an inquiry about my knee pain. The physician felt my knee, there were no x-rays taken, and determined that I should lose weight and walk 30 minutes a day. I left [the appointment] puzzling over how I would add 30 minutes of walking to days already filled with painful walking.

Scenario #2, I go to a treatment facility that participated in a “Health Fair” at the Botanic Garden, described in a local paper as “experts” in dealing with my issue. This time, I did get x-rays, which confirmed joint damage, there was no recommendation about pain, and they told me “maybe physical therapy would help.” I would be seen again in three months with no recommendation about how I would manage those three months. I did not go back.

I then go to a “Pain Institute,” somewhat against my better judgment, but I did get helpful physical therapy and palliative treatment for my knee. But I knew this was not going to resolve my problem.

I finally get to IBJI. I had two experiences that were special to me and were part of a recovery that by this time included mental and emotional exhaustion.

First experience at IBJI: My daughter Jenny accompanies me to the initial visit with Dr. Chams. X-rays are taken, the x-rays are explained, and the treatment options are identified and explained. During the discussion, I mention my granddaughter was having problems with her knee and was possibly having surgery. Dr. Chams took the time to explore this with my daughter. They discover he has contacts in Florida where she lives and a second opinion is later facilitated and it was determined that surgery was not indicated. This to me was an example of caring. Reaching out and taking the time to respond to a situation that could easily have passed unnoticed.

Second experience at IBJI: I was discharged on the second-day post-op on October 5th and went with my daughter to Jewel-Osco to pick up my discharge medications. We learned that the pain medication was out of stock until Tuesday which was four days away. As we are pondering what to do, Dr. Schwartz enters the store, acknowledges us, shares his observations of me in the parking lot about how well I was managing with my walker, and asks, “How are things going?” We explained the issue about the pain medications and he said he would “take care of it” and order a pain medication in stock. This wasn’t too easy, the pharmacist needed to make a call to clarify the protocol in filling this script directly from a physician!

Both these events demonstrate the impact of being treated as a person, the act of being “seen” and being “heard” and being responded to. This may not be important to some people, but it is important to me. This is the difference between providing care and managing care.

Roger Chams, MD is a board-certified orthopedic surgeon specializing in Sports Medicine, knee and shoulder disorders. He was fellowship trained at the prestigious Southern California Orthopedic Institute where he received specialized training in minimally invasive arthroscopic surgery of complex knee and shoulder disorders and sports injuries.

Brian Schwartz, MD is a board-certified orthopedic surgeon, fellowship-trained in Hip and Knee Reconstruction at Harvard Brigham and Women’s Hospital. His focus is on the preservation and reconstruction of the musculoskeletal system, specifically the hip and knee.