A few months ago I had the pleasure of caring for Maria, a 68 year old woman from Central America who still worked as a room attendant in a Las Vegas casino. She came to us directly from the hospital, where she had been admitted a week earlier for a fainting episode. She was lethargic and glassy eyed, disheveled and was pushed in a wheelchair by one of her daughters. She was on 27 different medicines prescribed by 11 different doctors, who obviously never communicated with each other. She was for instance on 7 different anti-hypertensive drugs, including 2 different doses of the same one, lisinopril.

I asked her daughter how on earth she was able to give her mother so many medicines- and she sheepishly admitted, “Well doctor, I actually didn’t give her all of them because I thought it was too many.” She was right, that many meds would kill a horse.

“So what did you do?” I asked.

“I let God decide,” she replied. “Each day I’d say a prayer, and then reach into the bag and pull out 5 medicines.” So on a day when she got one diabetes med, one anti-seizure med, and one or two anti-hypertensive meds, her mom did fine. But on the day God wasn’t paying attention and she pulled out 4 or 5 blood pressure pills, bam– fainting spell and to the hospital.

It took us about 2 hours that day to get old records, make a number of calls, and figure out what was really going on. I literally threw away 20 of her 27 medicines, told her to stop seeing 10 of the 11 doctors she was going to, and had our health coach spend another hour with the family explaining their conditions and what was needed to be done. We worked over the next few months on titrating her diabetes and blood pressure medicines, and got her on a healthier diet. I saw her last week and she walked in with a new hairstyle and makeup and had a twinkle in her eye. Her blood pressure and sugar were fine, and she felt great.

This story may be a bit extreme, but the basic outline is all too familiar. Patients too often are led to think the way to get good quality health care is to see a number of specialists for each organ system, such as a cardiologist to manage their hypertension, a pulmonologist to manage their asthma, a GI doc for their reflux, and so on. Unfortunately as in this case these docs usually only communicate by sending letters to a primary care doc, who is often the most out of the loop, and so you end up with awful outcomes like Maria.

For years health plans have tried to fix this fragmentation through nurses in a call center somewhere in the middle of nowhere, trying to get patients to somehow beg one of their many doctors to take control and reconcile the medications. Our intervention, simply taking over primary care, is so much more powerful. We simply stop the medications people don’t need, put them on what they do, fire the many excess doctors they are seeing, and help the patient and family make the right decisions about their care.