Appendix B: The First Primary Care Visit

Having survived the ICU as well as any additional care facilities prior to coming home, you are now ready to prepare for your first Primary Care office visit! This is a visit for which it is important to prepare as it is the first time that your Primary Care Clinician (PCC) will see you—and your family—after hospital discharge. You will immensely help your PCC by doing the following:

1. Bringing your discharge paperwork with you.

2. Preparing a list of the medications you are currently taking, and ask whether any of the new ones are still necessary.

3. Bringing a family member with you to provide history and perspective that you cannot provide (you may not remember a lot of what happened during your ICU stay).

4. Considering whether you:

   1. Feel as if you are back to your usual strength.

   2. Believe that you are thinking clearly and as well as you did before you became ill or injured.

   3. Enjoy relationships or activities as much as you did before being hospitalized.

5. Your family member that accompanies you should think about those same questions to provide an “external” perspective as well.

6. Prepare a list of questions regarding your current condition, especially things that are not going as well as you would like after hospital discharge.

Some of these questions—especially numbers 4 and 5 above—relate to the post-intensive care syndrome (PICS). Your PCC can help with specific referrals to aid with recovery, including managing a major consequence of critical illness—depression. When you cannot return to your normal activities, and especially if you are dependent on family members, depression is common and not a personal failing. You are not alone as many other patients struggle in exactly the same way. An ICU survivor support group is a great way for you and your family to address these kinds of issues, including PICS.

No question is unreasonable. Your PCC may need to discuss your current condition with clinicians who cared for you in the hospital before rendering a treatment decision. Don’t be surprised if they do not have an immediate answer for what to do since recovery after needing critical care is complex and can take months to even years to fully recover. As a general rule, the older you are, the slower is your recovery—especially if you need additional surgery to restore normal function. If you live remote from the facility that provided you complex care, ask your PCC about using Telehealth to help assess or coordinate unfamiliar aspects of your care. Remember that your PCC is trained to assess and manage a broad array of medical conditions, but will need to rely on specialists for unique aspects of care that support your recovery.