When the snowbirds return

Coordinating their care is a challenge physicians must plan for.

By William T. Sheahan, MD
Family Physician/Winter Park, FL

Like many physicians, I see my share of "snowbirds"—elderly patients who come from up north to spend the winter in Florida, Arizona, and other warm locales. They're usually here from November until May.

It's amazing how a person's health can change so drastically in the six months he's away. Invariably, when I see a patient who's just returned to Florida, he'll say that he's doing "just fine." But on further questioning, he'll tell a completely different story.

One patient greeted me recently with a smile and firm handshake and proceeded to tell me what a good summer he'd had up north. We had a pleasant chat about his golf game, and he asked about my family. It wasn't until I asked him if he was on any new medication that he let me know he'd been diagnosed with prostate cancer. Preoperatively, he'd been found to have significant asymptomatic CAD and underwent a CABG. Afterwards, he'd had a radical prostatectomy, complicated by a DVT and PE and had a Greenfield filter placed in his inferior vena cava. He now had urinary incontinence and erectile dysfunction, and was hoping I could start him on Viagra.

Likewise, I've had many patients come in for their first visit since being back and I've admitted them directly to the hospital for CHF or the like. Others tell me that their "northern doctor" had diagnosed them with a serious problem weeks ago, but they'd told him that nothing was going to keep them from getting back to Florida for the winter.

Obviously, these surprises wreak havoc with patients' care. As the baby boom generation ages, and as more seniors choose a snowbird lifestyle, we physicians need to do a better job of ensuring these patients' continuity of care—whether we see them in the north during the summer months or in the south during the winter.

First of all, we need to correspond with one another about our mutual patients. When someone leaves my practice to head north, I should give him a summary of his care for the previous six months, listing any new diagnoses and medications, and any recent diagnostic studies and hospitalizations. If the person would rather not hand carry this summary, we can fax it or e-mail it to his doctor up north. Second, if a patient needs an appointment soon after he arrives at his new location, an office staffer should arrange it to help prevent any scheduling delays.

It's an amazing group of individuals who live the snowbird life. Many remain young at heart and continue to have an adventurous spirit despite multiple medical problems. It's important that the doctors who care for them get to know each other. "Tag, you're it!" I'll say as the patient heads north. That's the best way to enhance the care of our mutual patients.

 

William Sheahan. When the snowbirds return. Medical Economics May 9, 2003;80:105.