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.
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.