Some of our patients face the onset of a psychiatric problem after a lifetime of none at all. Other patients require continuation of treatment for illnesses they have had for many years, except now they have to contend with age and its effect on how their medications are tolerated. We do a lot of dictating, we communicate a lot. Some of the more delicate issues involve working with specialists such as neurologists, with whom we share patients. We shouldn't interfere with their prescriptions and vice versa, but each of us needs to know in real time what each of us is doing.
Treatment needs to be choreographed.
And this includes dietary supplements and herbal remedies. I've actually had a patient who was delirious from dietary supplements. We stopped the supplements and the hallucinations disappeared. Fortunately, at Stanford electronic medical records and other tools are improving so we can routinely monitor patient medications more comprehensively. Julie spends a lot of time on the phone talking with referring physicians, making sure we're all on the same wavelength about patients' evaluations and treatments.