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The Sound of Music...


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J. Eric Hobson, MSN, CRNP
University of Pennsylvania Medical Center
Philadelphia, Pennsylvania, USA
Eric.Hobson@uphs.upenn.edu




A former colleague uses the analogy of an orchestra when she defines the roles and relationships staff fulfill and maintain in the care of transplant patients. Taking this orchestra analogy a bit further, by defining the roles and care design systems familiar to the members of the Society, we will focus on just a few sections of the orchestra. It seems fitting to assign the pulmonary system the brass section, as the instruments in this section rely on "wind" to produce their music. While the cardiac system could be assigned the percussion section, accepting that the "beat of life" is carried on by the drums.

My career in transplant dates back to 1997, and today, over fifteen years later, I still fulfill the role of the Transplant Nurse Coordinator, with the added responsibility of being a Lung Transplant Nurse Practitioner. Self-serving as it may seem, the Nurse Coordinator plays the role of Conductor, with no intention to slight my attending physician colleagues who might serve in the role of "Chair-person" of the Board. Of course, in this model, our section is filled with the most talented and creative "musicians" sitting in the "first chair", creating beautiful arrangements for each patient and family in our care. We rely on other sections to help add to the excitement and energy of the care we provide and optimize the "musical experience" of the transplant continuum and the support of the audience (think community) and generous patrons (think referring providers).

An alternate approach, and keeping on the musical theme, might be a Marching Band. The music may have appealing qualities, but often lacks the depth and diversity of an orchestral compilation. Members of the Band, however, are equally expert in their role. This approach could be viewed with the Primary Care Provider playing the role of the drum major and each instrument line from brass, to woodwind, to percussion, flags, rifles, and pom-poms each serve a unique purpose but may only play during a specific season or limited events.

The guidelines for care might be likened to sheet music. It connects the sections from beginning to end, providing both focus and background. It ties the experience together, and yet can be revised and rewritten to focus on specific qualities enticing each audience by enhancing the positives and limiting the challenges.

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[1,2,3,4,5,6,7,8,9,10,11,12,13,14]

That sheet music seems epic in scale and complexity for the optimization of care for the patient. And, most of the transplant patients are not straightforward and carry extra risk factors due to disease or side effects of therapy.

Health maintenance is an important aspect of the care of every patient. Some transplant programs may choose to take a proactive and comprehensive approach in their role with Health Maintenance assessment and patient compliance throughout their relationship with the patient. Thoracic transplant programs often maintain long term relationships with their patients and depending on the care demands of the patient may see patients more frequently than their Primary Care Provider (PCP). This would be the orchestra approach. The PCP is involved for support. Other programs may approach it in Marching Band Fashion. There is a time and place for everything. The PCP is the drum major and relies on each line, when called upon, to step up and fulfill their specialty role.

Setting expectations for patients and our PCP colleagues allows for clearly defined role assignments. Consistency is key for the patients and communication with the PCP is vital throughout the process to allow for smooth transitions in care. Making sure patients have a local provider may be critical for some and inconsequential to others depending on practice style and patient need. Regardless of which "musical" genre you and your team prefer, stay current and be aware of the guidelines and tap into the resource of the expert PCP whose involvement in this aspect of patient care can be invaluable.

As our care of the post transplant patient has improved over the years, the demands for ongoing health maintenance is ever present and increasingly demanding in our struggle to optimize the outcomes and allow patients to truly experience the sights and sounds of the music of their lives.

Disclosure Statement: The author has no disclosures, nor conflicts of interest to report.


References:

  1. Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer
  2. http://www.acg.gi.org American College of Gastroenterology - Colorectal Cancer Awareness PDF
  3. U.S. Preventive Services Task Force*; Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2009 Nov;151(10):716-726.
  4. Rex, D. K., Johnson, D. A., Anderson, J. C., et al. Am J Gastroenterol 2009;104
  5. New Guidelines for Cervical Cancer Screening
  6. U.S. Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Jul 2;159(1):51-60.
  7. Fitch A, Everling L, Fox C, et al. Prevention and management of obesity for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 May.
  8. U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Mar 19;158(6):478-86.
  9. Guidelines and Protocols Advisory Committee. Colorectal screening for cancer prevention in asymptomatic patients. Victoria (BC): British Columbia Medical Services Commission; 2013 Mar 1.
  10. Canadian Task Force on Preventive Health Care. Recommendations on screening for cervical cancer. CMAJ. 2013 Jan 8;185(1):35-45.
  11. Luehr. D., Woolley, T., Burke, R., et al. Hypertension diagnosis and treatment. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Nov.
  12. American College of Obstetricians and Gynecologists (ACOG). Osteoporosis. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2012 Sep.
  13. Wilkinson, J., Bass, C., Diem, S. et al. Preventive services for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Sep.
  14. U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Jul 17;157(2):120-34.



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