Case Management Focus: Setting Realistic Expectations in a Challenging Healthcare System

Sarasota, FL (WorkersCompensation.com) -- One of the most important things nurse case managers can do when working with injured workers and their families is to help them set realistic expectations of the healthcare system.

Before people enter the healthcare system, they think it is organized and coordinated and works for them. The reality is that the healthcare system works for the healthcare system and not the people who use it.

When people realize this, they can be demoralized and can lose hope. The role of the nurse case manager is to help their patients learn how to set realistic expectations so they can navigate the system and meet their needs.

Here are some tips you can use to educate and empower the injured worker you work with to become their best advocate.

Be organized: Help your patients understand that much information will come to them. This can be overwhelming, especially when they do not feel well. Recommend they get a copybook to list names, dates, and what was done at each entry. Note if they have to have a test done, go to therapy, or follow up with their doctor. Having things written down will keep them organized. Mark appointment dates on a calendar so they can keep appointments organized.

Prepare for appointments – Use the patient portal. Help them prepare for their appointment. Write down why they are attending the appointment and what they want to walk away with. A tool that will help them participate in their care is to sign up and utilize their patient portal. If they have lab work, x-rays, or saw a specialist, check to see if the reports are in their patient portal so they can make sure the doctor they are seeing has them and can review them at the appointment. Most portals allow the patient to print off the notes and test results. Having this documentation enables the appointment to be meaningful. Don’t assume the paperwork will be at your appointment. Check to be sure or bring the reports with you.

Write down questions and things you want to tell your doctor: Attending any doctor's appointment is hectic. The more organized the patient is, the more productive the appointment will be. Questions such as: How am I doing? What are the next steps in my plan of care? If the patient is taking a new medication, let the doctor know if there are any side effects. Ask if the medication is working. Is the patient’s pain relieved? Has the lab work normalized? Were there any challenges getting the medication, such as cost or access to it? Medications are costly – can the patient afford them? If not, investigate if there is a prescription assistance program to help with the costs. How does the patient feel about taking the medications? If they are having any issues, let the doctor know. Doctors and nurses want to help their patients but cannot do this unless the patient shares their concerns. Encourage the injured worker to Speak up!

Talk to the members of your healthcare team: Recommend that injured workers talk to all members of their healthcare team, including therapists, pharmacists, nurses, social workers, support staff members, the adjustor, and their insurance companies. Sharing concerns with their team members allows them to get various views and recommendations regarding resources that could help them.

Talk to the claims adjustor: Bring issues to the claims adjustor and work with them to devise solutions for your patients.

Read your member insurance handbook: Injured workers can have challenges not part of the workers' compensation case. In these situations, using their medical insurance is needed. When they have questions regarding their insurance coverage, they should read their member handbook that explains the policy. Many answers can be found in the member handbook. If they still have questions, have them call member services. As a nurse case manager, I sometimes make calls with them to ask direct questions and help the customer service people understand what the patient is asking.

I hope these tips help you help your patients set realistic expectations and learn how to be their own best advocate. If you are an onsite case manager, you can do many of these things in real time. If you are telephonic, it is not as easy – so touch base with your patient prior to any appointments and in between therapy sessions so you can help the injured worker as things happen. Have them report back to you so you know how things went and can follow up as needed.

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