Case Management is great work! I've done it for years and still find it satisfying. I think you will be particularly good at it. First, you have a very personal interest in contributing to the effectiveness and efficiency of your care and treatment. Second, and I think most importantly, you have tremendous experience as a case manager.

Now that I think on it, most of what I admire about you is associated with your case management abilities. When I teach and people ask me: What is casemanagement? How can so many different disciplines (social workers, nurses, insurance specialists, etc.) sit for certification in this practice? There is a very simple response: Case management is doing whatever it takes to make systems perform to the letter of their intent and coordinating those systems to produce the best outcome. I have always thought of you as a sort of macro-level case manager. Now you must take those skills and focus them at a micro level, at the health and welfare of one Eberhard Wenzel - you are well prepared for this most difficult task.

Coordinating appointments in complex care becomes an art form. Managing information is another of the big challenges. When you have been used to doing the majority of your work on the computer, lugging hard copies around with you in a binder is a bit different. Maybe your challenges in Australia are different. One of the challenges here is labwork. Everyone needs to see the lab reports, it seems no one but the ordering physician ever gets them. I make it a point to collect lab and test results as soon as they are available from the MD that ordered them or from the lab that produced them. I carry the results to every appointment. It is amazing how appreciative the MD's are - saying things like 'have the desk copy that for me, this lab is more recent than the one in your file'. You have the most recent report because the MD you are seeing today is not the MD you saw who ordered the lab work last week and the paper flow hasn't caught up with everyone just yet. Understandable but sometimes the lab results are critical in determining the 'treatment of the moment' - I prefer folks to work from the most recent info, I find the outcomes improve.

Another challenge is the facilitation of communication in a dispersed care environment. I keep a record with me of all communications and I get the names of everyone I speak to ( receptionists, appointment schedulers, lab techs, etc.). If communications seem contradictory to me I make everyone aware of who said what, when - again responses like 'oh, I didn't know Dr. had scheduled you for that lab tomorrow! Why don't we just add these test to the order and you won't have to come back again for another test?'

I wonder if you will be surprised at the volume of work it requires to arrange the care and treatment of just one person and am interested in how it compares to the care of whole populations? When this episode in your life has been successfully negotiated I predict you will produce something truly unique. I don't know if it will be a book, a web space, a system, or a piece of art. I think you will take this lump of coal diagnosis and squeeze it into a diamond.