Thursday, November 20, 2008

Hey Duke Hospital - it would be easier to use a gun & shoot my dad

Duke Hospital would save a lot of time if they would just use a semi-automatic gun and kill my 75 year old father.

All obvious sarcasm aside, my dad spent nearly three weeks in Duke University Hospital (North) in Durham, North Carolina because the Duke hospitalists failed to culture or even obtain an orthopedic consult on a foot wound.

The only way that I could keep dad calm during the last Duke hospitalization was to assure him that the Duke Clinic surgeon (an incredible human being and surgeon) was in charge.

My dad was discharged to home and Duke Home Health Care. Wow. Incredible nurses. I never expected such caring, professional and capable nurses. Every single person involved with Duke Home Health (from receptionists to supervisors to deserves great praise and gratitude.

I am having quite the time with good ole Duke University Hospital (North). Geez.

My dad was catheterized into the bladder after his first surgery (dad had four surgeries in three weeks - each one with general anesthesia!).

The whole purpose of the "hospitalist concept" is that the hospitalist is at the hospital and available 24/7 and then a health care resource person (usually a nurse) will ensure an appropriate and "kink-free" transition from hospital to home or nursing facility. It does not work ---- at least it does not work at Duke University Hospital (North).

The latest saga:

1. Duke Hospital Health Care Resource Person Number One -- "rescoure person" had no clue how to spell or title or work with patients

A day before the fourth surgery, "health care resource person number one" came into my dad's room and asked whether I wanted my dad discharged to home or a nursing home.

I told her that planning a discharge was a bit premature since my dad had one more surgery.

I also told her that I did not want my dad in a nursing home because I did not trust nursing homes to properly care for older people. I wanted my dad either home or in a rehab facility.

In fact, a Duke Clinic urologist warned me to never put my dad in a nursing home because nursing homes will cath my dad (it's a matter of convenience for the health care personnel). The Duke Clinic urologist also warned me that older men tend to contract UTIs in the nursing home setting. Often the only presenting symptom associated with a UTI in an elderly male is mental confusion. So, the uninformed medical care providers just diagnose dementia and ignore the UTI. The UTI worsens into the kidneys. The elderly man dies.

It is absolutely unbelievable to me that the health care profession does not understand that UTIs are very complicated and serious in elderly men. The UTI is especially complicated when the man has an enlarged prostate. (I'll return to this issue in a moment.)

The "health care resource person number one" told me that my dad would never be allowed in a rehab facility because he has dementia and needs a sitter constantly.

What? Dementia? My dad has a very serious infection (thanks, Duke) and gets disoriented. But no one has ever diagnosed my dad with dementia. In fact, I have asked neurologists and teams of neurologists and psychiatrists have examined my dad. No dementia. None.

I told "health care resource person number one" that I understood the importance of a sitter since dad was absolutely no weight bearing. But, no one had ever diagnosed my dad as demented.

Then I told "health care resource person number one" that the word "resource" was misspelled on her business card. Very professional. Good attention to detail.

2. Health Care Resource Person Number Two was competent

While I was home in Chicago, I was working with the Duke Clinic surgeon and the "health care resource person number two" on dad's discharge plan.

The plan was home with out patient physical therapy.

I insisted on a urine culture being performed since my dad had a bladder cath and he was prone to UTIs. I received an e-mail indicating that the Duke Clinic surgeon had placed the order for the Duke Hospital hospitalist to have urine cultures run for dad. Great. We are all working together well.

3. Duke Hospital hospitalist is not a good physician

I return to North Carolina and pick up my dad at Duke Hospital. There was no indication that a urine culture had been done.

It took three days for me to get the answer about the urine culture issue. The Duke University Hospital telephoned me and told me that it did not matter what the attending Duke Clinic surgeon ordered.

The hospital resident told me that his job was to do the most cost effective thing. The hospital resident told me that (regardless of what the attending doctor ordered) a regular urinalysis was more cost effective. It is just that simple.

The hospital resident told me that my dad had no symptoms of a UTI. Wrong. Remember the "dementia."

It was the hospital resident who freaked my dad out and disregarded our family's wishes by ordering a full blown psych evaluation. The hospital resident thought the psych evaluation was important because dad was sometimes confused.

(That psychiatric evaluation led to the diagnosis of "acute delirium caused by hospitalization." Then the Duke Hospital psychiatrist wanted to do a "full medical work-up" to rule out another cause of the confusion, such as an infection. Hmmmm .... UTI perhaps? But at least dad was freed from the "dementia" label)

First year medical school to the orthopedic , mental confusion is often the only (repeat, only) presenting symptom of a UTI in an elderly male!!!!

The hospital orthopedic resident was arrogant and rude to me during the telephone conversation. He tried to intimidate me. Very inappropriate.

The hospital orthopedic resident me that my dad could not have a UTI because the UA was negative.

The hospital orthopedic resident is uneducated and ill informed with respect to the complexity of UTIs in elderly men with enlarged prostates.

Moreover, the hospital orthopedic resident was wrong. My dad does have a diagnosed UTI.

The hospital orthopedic residentmissed the important diagnosis because of his arrogance, ignorance of the presenting symptoms of a UTI (mental confusion) and insistence to be "cost effective."

Hospitalist/orthopedic resident arrogance and unwillingness to follow the Duke Clinic attending surgeon's orders jeopardized my dad's life. Literally.


The irony of the hospital orthopedic resident's comment that a UA was "cost effective" is that it would have been most "cost effective" for the Duke hospitalists to have cultured and properly treated my dad's foot wound during the two week August 2008 Duke hospitalization.

Calculate that, hospital orthopedic resident.

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