I am not attacking Dr. Feda. I am sharing it because this was a frightening, confusing experience…read moreinvolving an older, medically vulnerable patient, and it still has not been handled or explained properly.
Dr. Feda is a younger, technology-centered physician, which may contribute to this impression. I am not blaming his age or generation. However, his approach feels impersonal compared with other primary care physicians I have experienced. During appointments, he focuses heavily on his computer, makes limited eye contact, can be short in his responses, and does not consistently provide the conversation and follow-up that help a patient and caregiver feel heard, supported, and confident in her care.
My greatest concern followed a serious blood-pressure episode in which her reading exceeded 188 and reached 210 before being stabilized. As her family member and caregiver at home, I first reported it through MyCS-Link and then contacted Dr. Feda's office directly. Only later did the in-home care team provide its information to the office. Dr. Feda called once, several days after the episode, when the immediate events had already occurred.
About one week after the episode, urgent care called asking us to bring her in but offered no meaningful explanation. Urgent care called twice again a couple of days ago, still without identifying the clinical concern, what they wanted to evaluate, whether testing was planned, or how urgently she needed to be seen.
Her blood pressure had since been maintained, but I was not unwilling to obtain additional care. I repeatedly asked a basic question: Why are you asking us to come in, and what does the doctor want urgent care to evaluate? Nobody could answer.
That is why I did not immediately agree to bring her in. I was not refusing an appropriately explained recommendation. I needed enough information to make an informed decision for a vulnerable senior. Preparing and transporting an older patient for an unexplained urgent-care visit burdens the patient, her in-home provider, and the family caregiver. We needed more than repeated calls saying only that she should come in.
I expected Dr. Feda or a covering clinician to explain: "I reviewed what happened. Although her blood pressure has stabilized, I want urgent care to evaluate a specific concern, conduct testing, or rule out a possible complication. Please take her in within this timeframe, and watch for these symptoms." Nobody provided anything resembling that explanation.
Although Dr. Feda's approach appears highly technology-centered, MyCS-Link has not produced timely or effective responses when the patient's condition has become more urgent. I understand it is not an emergency service, and I do not expect a physician to monitor it every minute. However, when a message reports a serious change in an older patient's condition, the practice should acknowledge and clinically triage it, route it to the physician or covering provider, and give the patient and caregiver clear instructions. This was also reported directly to the office, so it did not depend solely upon a portal message.
This could have been handled differently. The office should have reviewed the caregiver's report and contacted the in-home care team directly for the patient's readings, symptoms, medications, observations, and actions taken. Dr. Feda or a covering clinician should then have documented one clear plan.
Urgent care should have received the reason for the referral before calling us. Its staff should have explained why she needed to come in, what was being evaluated, how soon she should be seen, and what to do if her condition changed. The patient, in-home provider, and family caregiver should all have received the same instructions about what to monitor, whom to contact, and the next step.
AHRQ defines care coordination as organizing care and sharing information so the right information reaches the right people at the right time. Federal standards for Medicare-certified home-health agencies require prompt clinician notification when a condition changes, coordinated care, and caregiver involvement.
Instead, I was left connecting the pieces among Dr. Feda's office, urgent care, and the in-home care team. That should not become the family caregiver's responsibility. If technology replaces some personal interaction, it should make communication faster, clearer, and better coordinated--not leave the caregiver wondering whether an important message was received, why the office keeps calling, or what the patient is supposed to do.
The experience felt scary, odd, and unnecessarily confusing. It could have been handled with greater attentiveness, a direct explanation from the doctor, and one coordinated plan centered on the patient's safety and well-being.
Sources: AHRQ Care Coordination, https://www.ahrq.gov/ncepcr/care/coordination.html; 42 C.F.R. §484.60, https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-484/subpart-B/section-484.60
