My Mother’s Small Stroke and the Hospitalist

Last Wednesday, my 90-year-old Mother (who looks 70, acts 50 and wheels a mean walker) had a stroke. It took awhile to learn that it was a “mini-stroke,” or a TIA, which are one and the same I believe. It was a small event for her at the moment, which happened while she was having dinner with friends at the Assisted Living facility where she lives. She apparently put her head in her hands and something happened to her vision. The staff was assisting within minutes and her blood pressure was over 200/100. As the night went on in the ER, I watched it go to 266/137 and stay there for a very uncomfortable time. But what I want to tell you about is the “Hospitalist.”

If you haven’t had a reason to deal with a “Hospitalist,” count yourself among the blessed. This is the second time for my Mother this year. I think most of the reputable hospitals in this city use them, and I have no complaint about their competency based on my family’s experience, but…

I do have a problem with the way they avoid proper discharge paperwork. They know State Law for a patient like my Mother. I do have a problem with the way they take current medications prescribed by my Mother’s primary physician and change it down to little things like calcium, Ocuvite or Centrum Silver. My Mother cannot take Calcium. Ocuvite has nothing to do with why she was hospitalized and she has difficulties taking vitamins. At 90, give the woman a break – vitamins will not save her life – she plays bridge, poker and bingo, still attends church and goes out for lunch several times a week.

So twice now, when she has been discharged they give me prescriptions (and some they do not give me). They give me unsigned “doctors orders” which mean zero in a well-run Assisted Living environment. When we arrive back at Assisted Living late in the evening on a weekend night, because the Hospitalist didn’t show up until 7 pm, my Mother is admitted “back home,” without signed doctor’s order, because no matter how I insist, they won’t sign anything. I take her home anyway. The Assisted Living nurse hates me because its the weekend and she’s not back until Monday.

This time, we thought the only change was an addition of a different blood pressure medication – no other changes. Today we find that there are many other changes that will cost my Mother a LOT OF MONEY – and that as soon as she sees her primary doctor later this week, he will discontinue most of them. The Assisted Living facility must order these Meds to be in compliance with State Law, and the State doesn’t mind spending my Mother’s money.

The Hospitalist doesn’t mind fussing with the Primary Doctor’s orders. After her January hospital visit, it took us two months to get her Meds straightened out again. The Doctor said there is nothing he can do about it. This is the way it works. So while she went home with a new BP med, we found today that he had also increased the BP med she has been taking from 40mg to 540mg! And my Mother’s facility had to force the hospital to send over signed orders or we would not have known.

…hospitalist compensation continues to grow, with the mean total compensation of hospitalists coming in at just under $230,000, and almost 1/3 of hospitalist compensation packages worth over $250,000 a year.

So, it’s a win-win for everyone but the patient and the patient’s family. The Primary Doctor doesn’t have to trek to the hospital. The Hospitalist doesn’t have to pay for an office for a private practice, needs no bedside manner, needs to know little about the patient – can bring down the blood pressure in my Mother’s case, and still tell her to take Benefiber, which she already does. The Assisted Living facility will order it anyway, even though she already has it. It it was apparent that my Mother had no primary physician, I can understand, but it’s in the records. She has a doctor. He knows it! She isn’t on Government assistance.

Note to Hospitalists in Tulsa, Oklahoma: Please improve your discharge planning. Sending a patient home with incomplete information should be easily preventable. I guess it’s too much to ask to let the Floor Nurse on the 5th know approximately what time of day or evening you MIGHT show up within say, 4 hours one way or the other? Anyone else out there had this experience? Graphic credit.

 

  • I chaired a hospital’s Quality Assessment and Improvement Committee for many years, and worked in that hospital for three years.

    Hospitalists are a capitulation to attending physician’s desire to not have to take call and be disturbed nights and weekends.

    There are some very good doctors who are hospitalists, but by virtue of their job, they simply do not have the necessary connection with patients.

    I’m sure this situation will not improve under Obamacare.

    • Hi James, thanks for weighing in. I think it will be horrible under ObamaCare. I doubt they will even see a 90-year-old woman who simply needs her BP meds adjusted. I had no quarrel with the information he gave us about the stroke, and the details of it, although it comes fast and furious. I just don’t understand why, if they have so little time, they will concern themselves with things like calicum and Ocuvite! Nice to see you:-)

  • I don’t know the specifics of your mother’s situation, and I’m not a doctor, to boot, but I am very well educated on the personality of physicians (as a group) and many of them frankly believe they are the smartest people on Earth. The best docs, in my experience, are not locums or hospitalists, but in private practice, or in hospital-owned practices where they have a stable patient base that they are intimately familiar with.

    Hospitalists are responsible for taking care of someone else’s patients (most of the time), but can’t get past the idea that they are not the primary physician.

    We had one guy at our place who would berate patients. That didn’t last long, and he was gone shortly thereafter, but the physician ego not infrequently interposes itself between the patient and quality care.

    The hopsitalist concept has positives, of course, but often they are outweighed by the negatives.

    • James, yes, we chose a doctor because we believe they will do their best to take care of us. Then when we are the sickest, and end up in hospital, we get a Hospitalist who knows nothing about us and isn’t going to spend much time finding out.

      Once you are released, the idea is that we get back to our doctor pronto so that he can “fix” what the Hospitalist did. If the problems were occurring with me, I can do what I want, but in Assisted Living you do what the last doctor tells you to do. If you leave the facility to get care, someone has to send instructions.

      My Mom takes little medication, but her BP is way out of control – ONLY IN THE EVENINGS! She leads a very full life considering her age and we don’t think she has anxiety. Her BP meds need to be changed or adjusted – with nothing done to her calcium:-)

      Honestly, both of the hospitalists she has had are polite enough, but it’s just another stop in their day.

  • This is the first time I’ve ever heard of “Hospitalists.” Now I have to hit the internet and find out what this is all about.

    In the meantime, I’m glad your Mom is doing better. Prayers for her and for you…

  • …and your Mom sounds delightful. My Mom died when I was 36, so I have been “mom-less” for about 30 years. Not a day goes by that I don’t miss her.

    • Adrienne, she is delightful and I am so fortunate to still have her. She’s the best joke teller and the Med Techs at her place just love her. They treat her like a girlfriend. She is a wonderful Mother. Thanks for the prayers!

  • Prayers-across-the-miles for you and your dear, sweet mother, Maggie

  • Geo

    Best wishes Maggie, will keep you and Mom in our prayers.

  • Hi Maggie, prayers for you and Mom. (((hugs)))