IR and Transitions of Care

In this issue of Seminars, Strain and Nelson wrote a meaningful article on the need to more effectively transition care of patients with vascular anomalies from pediatric to adult caregivers. The need to do so extends beyond just the population with vascular anomalies, of course. Patients with sickle cell disease and those with cystic fibrosis are other good examples of populations that need a transition of care, and I'm certain there are many more that escape me right now. Transitioning from pediatric caregivers to adult caregivers requires much more than a simple phone call, however—in many cases, it requires a fund of knowledge and a degree of compassion that many of us living in the adult world of IR cannot understand completely if at all.

Take a patient with cystic fibrosis, for example. When that individual reaches a certain age, they may no longer be able to obtain care from the providers who have been caring for them their entire life. In many cases, I'm sure that they can receive care from that provider, but due to circumstances beyond their control (insurance, hospital, provider groups) and even in the setting of both the patient and provider wanting to continue their relationship that may prove to be impossible. How, then, does that patient receive the care they need and the type of care they have come to expect? Being treated in the pediatric world, either as an outpatient or an inpatient, is wildly different that being thrust into the adult world of care. Nearly all of us, I'm sure at some point, have spent time at a children's hospital, where the number of patients seen each day may be a fraction of the number being seen in the adult world. The sense of urgency, the pace of the day, or sometimes resource allocation is simply very different between the two settings. From where this arises, I'm not certain, but the difference is marked and palpable. And, of course, if we as providers feel the difference, one can expect that the difference from the patient's perspective is even more pronounced.

Knowledge gaps are an important limiting factor for patients transitioning care as well. During my medical school training, cystic fibrosis was a universally fatal disease. Few patients at that point survived to adulthood, and so those of us in the adult IR world never saw patients with advanced disease. Of course, I also took care of patients with leech-prescribed therapy (true), who had to drink their own bile (true), and those with imbalances in their black and yellow bile humors (maybe a stretch). How do we train ourselves to close any knowledge gaps that exist so that we can care for these patients as best we and the system can?

I believe the answers to these questions arise from the essence of IR as a field. First, we have a basic skillset that is completely translatable to nearly every disease process in nearly every organ system. There is rarely a procedure that needs to be performed that leaves us completely stumped. Second, we are now being trained in and understand the importance of longitudinal care—not just for the pediatric population but for adults as well. In the past, patients with chronic illnesses were simply seen by whomever. Now, however, many IRs have longitudinal care relationships with their patients, improving long-term goals and patient–physician relationships, and decreasing the likelihood of miscommunication that may be detrimental to patient-centered outcomes. Finally, and perhaps most importantly, we have a community that is open to hearing from one another, whether to curbside consult or to provide a direct referral. We can simply text, email, or pick up the phone to connect with a colleague. It is this intimacy within our specialty that makes us stronger, forward-looking, and patient-focused.

Publication History

Article published online:
07 November 2024