Do docs really even care about their patients anymore?

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Specializes in Hemodialysis, Home Health.

AAAAAAAAAAAAAARRRGH !!!

What IS it with doctors these days??? Have they just stopped CARING about our elderly population altogether? Do they just want to rake in the $$ but brush off legitimate c/o's ? How many times does a nurse have to fax and/or call before they take seriously what you are telling them about their patient, and choose to intervene, and intervene appropriately???

Of course, coming from the dialysis arena, I'm not too used to dealing with many docs... just one..our nephrologist..and who was also the medical director.

But now in HH I'm seeing things that make me want to spit! :angryfire

I had one patient taken to the ER last night, AFTER I had already done an unscheduled visit with her in the afternoon, as requested by her pleading dtr. Over the past week her mother has been having what I considered to be TIA's... never had these before, getting worse, longer and longer periods of "zoning out", stuttering, unresponsive to visual or tactile stimuli, and even drooling during these times.

Some would last up to 15 minutes or more, according to the dtr. When the dtr. first called the doc about these episodes, the doc simply told her to DC her xanax.. nothing more... did not ask to see her, nothing. Just brushed the daughter off. Of course I faxed the doc with my findings as well.. to no avail. When I went in to see her again yesterday, the pt. was just stuttering up a storm, trying so hard to get the words out. Eyes pleading to be heard and understood. Left upper extremity pitting edema, body hurting all over according to dtr.

VSS all stable, PERRLA, but just stuttering and blubbering. Went back to the office and faxed all my findings once again, stating that this was NOT the patient I had been introduced to only three weeks ago. The dtr. had called hte doctor office three times in this week asking for bloodwork orders for us to draw... never a response. Finally yesterday, after I called from the pt. home, they gave us an order for a CMP and CBC.

Last night (I had call) the dtr. calls me stating her mother was not able to hold a cup, or even drink from a straw... would reach for them and miss every time, and when she attempted to feed her, the liquid or food would just roll out of her mouth. Her gaze was far off and she was just "out of it". I told her to get her to the ER stat. Sure enough, this morning they tell me she was having TIA's and LOTS of them.. did a cat scan, etc. Mentioned carotid surgery, etc.

So tell me WHY would her doc not see her before this, after both her dtr. and I calling, faxing, doing everything in our power to get her attention?:nono:

What about my sweet little lady with CHF, hx. of Afib, severe mitral insufficiency.... who can NEVER give me an adequate O2Sat? In the seventies and low eighties EVERY time, SOB episodes leading to frequent falls. I spend nearly an hour with her alone, just trying to get those sats up to 90.. massaging her arms, fingers, etc. Doc merely says for her to wear her 02....well, she HAS been ! 24/7. This has been going on for nearly two MONTHS! He sees her, nothing changes, except diddling with her fluid pill a bit here and there. She has no adventitious breath sounds, no pedal edema... she is simply severly hypoxic, dang it !:madface:

Is there any reason for her not to be on digoxin? She used to be and says felt better then, but it was DC'd back in January before I got to know her. Any reason with her medical hx. she would not be a candidate? You guys no more about this stuff than I do. Just curious.

I have called and faxed her doc over and over as well.... they check her out, send her home, and "come see me in another month or two..." Her son is livid. This is one precious, spunky, life-loving little woman, who loves to be active, and now spends most of her time avoiding falls d/t hypoxia.

I say she needs another thorough cadriac work-up at a REPUTABLE institution with some docs who actually give a hoot. GRRRRRRRRRRRRRRRRRRRR !!!!! :angryfire

What say you? I'm foaming at the mouth here. Truly.

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Specializes in LTC, assisted living, med-surg, psych.

Welcome to geriatric nursing, netters! This is more common than you'd believe.........I've seen so much of this in long-term care that I just don't even put up with it anymore---the key is to be firm with the MDs and insist that they take care of their patient. I've had to nag some docs to the point that they've learned to deal with the patient sooner rather than later, just to get me to shut up and get out of their faces.........it sure didn't make me any friends, but as long as the resident gets the health care they need, I'm happy.

Sounds like you need to do some tough love with those MDs, jnette; I think the problem lies with the fact that many doctors don't enjoy geriatrics---it's not 'glamorous', like plastic surgery or OB-GYN or orthopedics. Not that all docs neglect their elderly patients, but I've seen time and time again how patients just sort of drop off the MD's radar screen once they hit 65 or get admitted to a nursing facility. Looks like it's like that in home health, too......good luck, my friend, you'll need it.

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Specializes in Hemodialysis, Home Health.
Welcome to geriatric nursing, netters! This is more common than you'd believe.........I've seen so much of this in long-term care that I just don't even put up with it anymore---the key is to be firm with the MDs and insist that they take care of their patient. I've had to nag some docs to the point that they've learned to deal with the patient sooner rather than later, just to get me to shut up and get out of their faces.........it sure didn't make me any friends, but as long as the resident gets the health care they need, I'm happy.

Sounds like you need to do some tough love with those MDs, jnette; I think the problem lies with the fact that many doctors don't enjoy geriatrics---it's not 'glamorous', like plastic surgery or OB-GYN or orthopedics. Not that all docs neglect their elderly patients, but I've seen time and time again how patients just sort of drop off the MD's radar screen once they hit 65 or get admitted to a nursing facility. Looks like it's like that in home health, too......good luck, my friend, you'll need it.

You're speaking to the eternal idealist here, Marla.... that is sooooo UNACCEPTABLE to me !!! So very, very WRONG. SHAME on them !!! :trout:

:trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout:

There. I feel better.

And what about when you try to call these docs at the office.. they are NEVER available to speak with, you ALWAYS have to go through their nurse, who often times is "away from the desk" or "with the doctor" and to "please leave a voicemail"... I don't know HOW many times I've heard THAT when I really, really wanted to speak to someone. And forget them calling you back... the patient would be dead by the time they did that. :madface:

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Specializes in LTC, assisted living, med-surg, psych.
You're speaking to the eternal idealist here, Marla.... that is sooooo UNACCEPTABLE to me !!! So very, very WRONG. SHAME on them !!! :trout:

:trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout:

There. I feel better.

And what about when you try to call these docs at the office.. they are NEVER available to speak with, you ALWAYS have to go through their nurse, who often times is "away from the desk" or "with the doctor" and to "please leave a voicemail"... I don't know HOW many times I've heard THAT when I really, really wanted to speak to someone. And forget them calling you back... the patient would be dead by the time they did that. :madface:

And the 'nurse' is usually a medical assistant, not an LPN or RN.:madface:

I've always been careful not to waste doctors' time, but I also want them to respect MY time in return. Over the years, and at different places where I've worked, I've managed to "train" all but a resistant few to respond promptly whenever I fax or call them; where I work now, there are only two MDs who sometimes need a follow-up fax or phone call. I refuse to accept second-class treatment for my residents, and they know it.

For emergencies, however, I don't even bother with the MD office, except to let them know I've sent their Coumadin patient to the ER for an episode of epistaxis that has made their apartment resemble a crime scene.........:uhoh21:

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And what about when you try to call these docs at the office.. they are NEVER available to speak with, you ALWAYS have to go through their nurse, who often times is "away from the desk" or "with the doctor" and to "please leave a voicemail"... I don't know HOW many times I've heard THAT when I really, really wanted to speak to someone. And forget them calling you back... the patient would be dead by the time they did that. :madface:

What's even worse is when it is after hours and you can only contact them through an answering service, and instead of the doctor calling you back the answering service calls back with so-called "doctor's orders."

Unfortunately, I am all too familiar with the way doctor's treat their elderly patients. This is the honest to God truth, the medical director of a nursing home saw my supervisor changing the dressing on an elderly, demented patient's leg and asked, "what do you want to save these people for? There are dozens waiting to fill up the beds."

What I have seen on parts of the doctor's and even a few nurses has really shaken my faith in the medical profession and even humanity in general. If I ever know I am going to end up in a nursing home I will shoot myself first.

My favorite patients are the elderly patients, and it sickens me the way the are treated like expendible nuisances.

Doctor's may as well have the title MBA behind their name also, because it is all about business to them.

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Specializes in Utilization Management.

OK, please don't flame me for this, but why was the TIA patient not sent to the ER days before with s/s like that?

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Specializes in ER.

I wonder too, although I'm pretty sure jnette was right on top of it all the time.

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Specializes in ER, NICU, NSY and some other stuff.

When I ws working hospice I was known to go and plant my happy little hind end in the doc's office until I saw them and had a face to face. After that they usually responded to any faxes that I sent promptly.

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Specializes in Utilization Management.
I wonder too, although I'm pretty sure jnette was right on top of it all the time.

Oh, absolutely agree there! Jnette, please understand that I'm not questioning your judgment in this situation.

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I find that unacpectable of the doctor to do that.

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Specializes in Hemodialysis, Home Health.
Oh, absolutely agree there! Jnette, please understand that I'm not questioning your judgment in this situation.

Ask away... I'm NOT always on top of things as I'd LIKE to be! This is all pretty new to me still.. when to call/fax the doc and when to send to ER.

And I come here to LEARN from all of you, too, so pipe up !

The patient had some "zoning out" episodes during the week and when the dtr.call re these (and I had followed up with a fax) she merely responded by telling the dtr. to dc her xanax.

The night I told the dtr. to get the pt. to the ER was after she called telling me she was stuttering/blubbering and wasn't able to reach for her glass or spoon, etc. Then I KNEW sth. was most definately wrong and she needed to be seen. I had already faxed this doc in the afternoon, prior to this incident, informing her that this pt. needed to be evaluated, as she was exhibiting behaviors which were so unlike her. And before the dtr. called me at home that night, she had called the doc... and after 45 minutes of no response from the doc, she decided to call me.. that's when I told her to call 911 and get her on her way.

I'm still finetuning my judgement calls out there in the field... as to what is a true emergency and what can wait until the doc gets back to you. But I'm learning that I can't rely on the docs to get back to you with orders, or even to the family. Even after this ER visit, (the doc wasn't there),this doc won't see the pt. until the 12th of May for an appointment. I'm thinking is she waiting for this pt. to have the BIG ONE??? :confused:

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Specializes in Hemodialysis, Home Health.

And as for my little lady with the poor O2 Sats which the doc is well aware of as I've faxed him NUMEROUS times and they just keep telling me to tell her to wear her 02 24/7.... I did make a referral to the respiratory therapist. Thought he might have her do an overnight 02 sat reading at home..see what her sats are doing. Maybe THEN her doc will take a closer look.

Again.. I'm not quite sure WHAT I'm supposed to do with her? Her doc KNOWS what's going on, and here I am stuck in the middle. Do I send her to the ER with these sats? They've never been able to help her in the past, even when she WAS hospitalized... just gets sent home with the same old problem.

I think she needs a thorough cardiac work up at a reputable insitution. Hx. of severe mitral insufficiency and CHF... what do you all think? Would she benefit from digoxin or not? She HAD been on it early this year, then the doc took her off of it. Seems to me like she's not getting enough cardiac output and therefor also not enough 02... but this past dialysis nurse feels like a fish out of water sometimes, as I've no real experience with many of these things. That's where "specializing" can bite you in the butt! :uhoh21:

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