Would you like a Rheumatology Care Coordinator?

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By Dr Irwin Lim, Rheumatologist

We would.

When my father was unwell with cancer, we received wonderful, multimodal and multidisciplinary care at the local teaching hospital involving different medical specialists, multiple radiation technologists, general and infusion nurses, dieticians, CT and MRI technicians, pharmacists and general administrative staff. We had to visit a number of hospitals, and even many different parts within a hospital's grounds.

It was a lot to juggle and a lot to take in. It would be very hard for the patient without support. There's family of course but even then, things can be bewildering.

The system had a coordinator. We met her on the 1st day. She seemed to understand, and gently, filled in a book with the appointments in a list. My family were given her phone number and her email, and we were told that she was there to help navigate the system. Comforting and practical.

Everyday, I diagnose then have to explain to a patient that they are suffering from a chronic disease.

This is a big deal.

There's usually lots to learn about the disease, about medications, about outcomes. There's usually investigations to be done and treatment to be outlined. I assume there's only so much the person will be able to digest, and remember.

Then, there's the logistics of organising the investigations and organising the appointments. And there's always that question that comes to mind after the consultation when it's not so easy to get an answer from the doctor.

With the chronic arthritis and chronic rheumatic diseases I treat, wouldn't it be good if there was a Rheumatology Care Coordinator to help?

We've been thinking about this for awhile and it's time to trial the idea at BJC Health.

The Keys Tasks for the Rheumatology Care Coordinator

1. Provide an additional education service;
2. Act as a key patient advocate, constantly improving the patient journey;
3. Coordinate the various referrals from the Rheumatologists to other health team members, making this simpler;
4. Act as a role model for Connected Care;
5. Improve the effectiveness of our rheumatology service to improve outcomes.

What do you think? We'd love to hear your ideas and thoughts about such a role.