Do docs really even care about their patients anymore?

[jnette]

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?

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 !

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.

[UM Review RN, ASN, RN]

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 therefore 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:

Gosh, if I were the doc I might want some ABGs or something. How's her level of consciousness? Alert & oriented X3? or does she seem to have more confusion than usual?

A BNP would be good to dx an acute episode of CHF, and of course, with CHF, she's been getting daily weights and sticks to her low sodium diet, right?

Any edema? Does she sound wet or crackly? Labored breathing?

All our CHF'ers are told to come to ER if they have more trouble breathing or if their weight increases.

Not dx'ing you understand....just suggesting what we might do based on some observations.

And of course, we'd do what you first said needed to be done--a full cardiac workup. Is the doc a cardio doc????

[UM Review RN, ASN, RN]

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???

Oh, I get it. It was one of those developing things that started subtly.

I would've done the same thing. I would have hoped they did a CT head, and all that stroke workup stuff.

Did her s/s resolve or does she still have them? I'm assuming that her s/s resolved. Not much you can do except to get her to ER by ambulance within 3 hours of onset of symptoms, like you would for any suspected stroke.

[jnette, ASN, EMT-I]

Oh, I get it. It was one of those developing things that started subtly.

I would've done the same thing. I would have hoped they did a CT head, and all that stroke workup stuff.

Did her s/s resolve or does she still have them? I'm assuming that her s/s resolved. Not much you can do except to get her to ER by ambulance within 3 hours of onset of symptoms, like you would for any suspected stroke.

Yes. they did a CT for head... they said she was having TIAs... but she was released to be followed up by appt. with PCP. Nearly two weeks fom now, though???

And yes... she still has ongoing episodes... she's FINE at times, then slips off at other times. When I saw her yesterday, she was doing ok still, but she comes and goes... gave the dtr. some education materials on TIAs and CVAs and told her if she were to exhibit any of these symptoms over the weekend, and she had any concerns to call the agency nurse on call or get her to the ER again.

This sure is a learning experience... :uhoh21:

[SueBee RN-BSN]

I would have sent her to the ER, and put a stop to the nightmare.

[weetziebat]

Jnette, in my new job only a month, and thought I was the only one finding that physicians really do not seem to give a hoot about anyone in a LTC facility.

Can't tell you how many times I've faxed, re-faxed, called, re-called, re-faxed - all in vain. And not about minor scratches. Issues that I'm certain would get almost immediate attention if the patient were in their 30's.

It does indeed seem as though docs are tired of problems associated with advanced age and just want all the old folks to just roll over and die.

And with our census at well over 100, we're dealing with almost as many docs. Don't know whether to pull out my hair, scream, or just go and screech in their faces.

What a shame it has all come down to money. Forget 'First do no harm' - nowadays its 'First check the insurance benefits'. :angryfire

[UM Review RN, ASN, RN]

What a shame it has all come down to money. Forget 'First do no harm' - nowadays its 'First check the insurance benefits'. :angryfire

Boy, you got that right weetz.

[SueBee RN-BSN]

If money is everything, have the family put a lawyer on the trail.

[VivaLasViejas, ASN, RN]

Jnette, in my new job only a month, and thought I was the only one finding that physicians really do not seem to give a hoot about anyone in a LTC facility.

Can't tell you how many times I've faxed, re-faxed, called, re-called, re-faxed - all in vain. And not about minor scratches. Issues that I'm certain would get almost immediate attention if the patient were in their 30's.

It does indeed seem as though docs are tired of problems associated with advanced age and just want all the old folks to just roll over and die.

And with our census at well over 100, we're dealing with almost as many docs. Don't know whether to pull out my hair, scream, or just go and screech in their faces.

What a shame it has all come down to money. Forget 'First do no harm' - nowadays its 'First check the insurance benefits'. :angryfire

Know what you mean, Weetz! I have a resident who's been on 40 mg of Lasix daily without any K+ supplementation, and she started c/o leg cramps last Wednesday......well, DUH! So I faxed the MD asking for some K+, got no result, so I called the MD, again with no result. I faxed again, called again---over a span of 2 days, mind you---and only Friday night did he deal with the situation. :trout: For all we know, she could have been seriously depleted.......she was also more confused and lethargic than usual, but did anyone but me worry about it?

Now I'll play devil's advocate for a moment. Doesn't it seem like at least half the residents in your facility have family members who get ridiculous and demand everything be done RIGHT NOW? I'm sure doctors get as cynical as we do after dealing with them for a while. Just now I got off the phone---at home, no less---with an MD who got a frantic call from one of our resident's DIL, demanding that something be done about her constipation immediately (the typical Sunday night 'emergency' that's been brewing all weekend:madface: ).

Meanwhile, my staff was going out of their minds---the DIL asked repeatedly to talk to me, but I knew if I allowed it even once, she'd feel free to call me at home at all hours of the day or night, weekends, holidays, you name it---and since unlicensed caregivers can't take a phone order, I figured it would be far better to just have the MD call me and give the order so they could go ahead and give the Fleets. But at least this one cared enough to do that much.........I can't say that about all of 'em, although most of the doctors I deal with on an everyday basis are pretty darn good.

Oy vey.......the things we go through!

[leslie :-D]

i have always found it most helpful when the md's know i am keeping very detailed nsg notes....."md notified at 1400; return call pending"; "reported s/s, chief c/o, vs and rn concerns of patient x. nno". i've also noted conversations between the md and myself.

you get the idea. once you see it in writing, the pattern of neglect and delaying tx is often the motivator needed to get these bozo's treating their pts more responsibly.

leslie

[lamazeteacher]

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.

___________________________________________________________

I've been in Home Health many (15) years, for many agencies, and most won't rock their boat by bringing a doc in line. The thing I've learned to say, is that I'm concerned that the patients' doc doesn't return calls, to the family, and suggest they call the doc's office or make arrangements that will let their family member have better care.

Working as a private contractor, I may not get calls from that agency for a while, but others provide cases......

Thank you all for your concern about seniors. I'm 68, and even though we've had Presidents well over my age, somehow those in the healthcare business think we're cretins. I've lost permanent full time jobs when people find out how old I am (I don't look my age, color my hair...).

Health insurance companies inform my employers about my age when I become eligible for healthcare benefits, even though I've said I don't need them (as I'm on Medicare). The insurance companies charge employers a larger ($1000+ per month) premium for employees over 55, and when Medicare is on board, they won't allow that to be the "primary" insurance, as they want to collect even higher premiums.

When I visit my geriatric doc, her staff treat me like I'm an idiot! They know I'm an R.N., but will give me misinformation, and when I tell them I know it's wrong (nicely), they report me as being uncooperative. When I had a bad "cold", I was to be seen between patients, and placed in the darkened "treatment" room, which hadn't been cleaned from the last procedure, as I sat on goo. My VS wren't taken. I reported that to the clinic administrator who voiced sympathy, and soon changed departments.

The final straw was being told that I had "missed" an appointment, when I was 5 minutes late. They said it had been a half hour earlier. Unfortunately, I didn't have the appointment card with me, and denied that. Again I was reported - for being the cause of a "disturbance" (no one else was in the waiting room). I wrote my doc, including a copy of the appointment card, with the time as I'd said. The result was my being discharged from her care, by letter.

I claimed "abandonment" to the medical Society (that was dumb, as docs pay for membership to that org) to no avail - not that I wanted her as my doc after that!

Then another doctor at Sutter, a conglomerate of hospitals, clinics, etc. in CA, refused to have me as a patient at all, and I was told by letter, that I could not see any physician there! I'm weighing a lawsuit, but can't spend time or money on that.

It could be that I freaked the doc out at a previous visit, when I said I was thinking about working as a legal Nurse consultant......

[caliotter3]

If nothing else, telling a doctor that you plan to work as a Legal Nurse Consultant would not be in anyone's favor when they are seeking medical care. Sort of like describing your last medical lawsuit while trying to impress the healthcare workers to give you proper care.

[lamazeteacher]

If nothing else, telling a doctor that you plan to work as a Legal Nurse Consultant would not be in anyone's favor when they are seeking medical care. Sort of like describing your last medical lawsuit while trying to impress the healthcare workers to give you proper care.

Actually Legal Nurse Consultants work for medical malpractise insurers, as well as personal injury lawyers. As ethical practitioners, it shouldn't freak good physicians if their patient has more knowledge about the legal scene. What I learned is that my doc isn't a confident practitioner, possibly with good reason.

I'm being interviewed by the other hospital in town, as a Legal Nurse Consultant, to work for them! Often lawyers who educate Nurses about their liability, haven't a whole picture of our responsibilities, especially as they relate to supervision of others. As a Nurse Educator, I look forward to assisting care providers to protect themselves in the performance of their duties.

Sharing who I am, assures that stress related work could affect my health, not the positions of others. I like to think that I present as the opposite of a threatening person, since I am understanding of their needs and cooperate fully in my care.