Saturday, February 21, 2009

Caregiving gets real

In the last few days I have learned about several older women who have cared for their husbands (of 50 plus years) just to have the medical community mistreat, misdiagnose and needless kill their husbands.

Hearing the heartbreak of one woman was very difficult for me (and especially my mom). But today my mom spoke with another friend of hers who also had the medical community mistreat and kill her husband.

I know that "kill" is a strong word. But it is the most appropriate word. I appreciate that there was no intent or motive to end the lives of these older men. However, the common denominator in the treatment of patients is lack of continuity of care and concern for patient safety. I also firmly believe that the medical community considers elderly patients to be a expensive and burdensome drain on scarce medical resources.

In my experience, medical professionals are quick to diagnose dementia and lack of mental function as a basis to institutionalize patients in nursing homes. These medical professionals conclude that there is no medical care necessary other than to keep the patient comfortable.

In my experience, hospitalists are a danger to health, safety and well-being of patients because hospitalists generally refuse to coordinate, communicate and cooperate with admitting/treating physicians. Hospitalists do not have the background knowledge of the patient's medical history. Lack of background knowledge is precisely the value of the hospitalist program model. Remember that hospitalists are treating your loved ones in a vacuum of the moment instead of in the historical context of the patient's health. This ignorance allows the hospitalist to focus on cost efficiency and getting the patient out of the hospital. Hooray for the bottom line!

I do not want any caregiver to feel guilty or responsible for the death or injury of their loved ones. Guilt is a unproductive and crippling emotion.

The delivery of medical care in our country has changed. The hospitalist program model is designed to treat hospital patients in the context of a "snapshot" as opposed to a "movie." Hospitalists care for patients instead of the treating or admitting physicians in order to (1) control costs; and (2) decrease the length of hospital stays. Whoopee.

Perhaps treating the patient in the context of a snapshot may be appropriate if the patient is relatively young and has not complicated or previous medical history.

On the other hand, if the patient is elderly and suffers with pre-existing medical conditions, then that patient should not (and must not) be treated as though the hospital admission exists in an isolated vacuum.

Perfect example:
My dad suffered terribly from skin breakdown as a consequence/side effect of chemotherapy. After months of the skin infection, dad again presented to the treating oncologist. At that point the skin was raw and literally smelled of infection.

The treating oncologist determined that my dad needed to be admitted to the hospital for three (3) days of IV antibiotics.

My dad arrived at the hospital and, as per usual, the admitting/treating oncologist was not a part of the hospital stay. Instead, a hospitalist treated my dad. And, that hospitalist examined my dad's skin infection as an isolated and snapshot medical issue.

The hospitalist saw no need for any antibiotics (IV, oral or otherwise). She kept dad in the hospital for the three (3) days and then discharged him with the comment that he was "fine."

Three days later my dad was rushed to the ED with severe pneumonia and very low oxygen level.

If the hospitalist had respected the admitting/treating oncologist's opinion and recommendations for my dad's care, dad would not have suffered the trauma of a ED admission and prolonged pneumonia.

The hospitalist screwed up. Sure, it was cost effective to deny dad the recommended IV antibiotics. But it was not cost effective for dad to be readmitted and suffer additional medical complications during his chemotherapy treatment.

It is my responsibility as a caregiver to advocate for my dad and demand that the responsible doctors be held accountable. That responsibility certainly does not mean a legal action. It does, however, dictate that I seriously discuss the matter with hospital administrators and accrediting agencies.

For me, being a caregiver is about more than simply holding dad's hand and waiting for him to leave this Earth. Caregiving is about making damn certain that my dad receives the medical treatment that he needs and deserves.

Medical professionals (or anyone else) who mistreats my dad absolutely will be held to account.

I hope that my advocacy and encouragement to others that they hold "bad doctors" to account will ensure a safer medical environment for others.

God bless those who have lost a loved one. You should know that mom and I wish there was something that we could do to ease the pain. We pray for you both to have the capacity to enjoy memories and the strength to continue (or start) taking care of yourselves. Believe it or not, at some point you will be able to forgive the "bad doctors" and replace the anger with prayers to God for these individuals.

The deaths and injuries from a flawed medical community needs to stop.

1 comment:

  1. Check out to see my personal transformation. The film reveals the raw realities of my fight to survive during open heart surgery while caring for my wife & my mother enduring life threatening illness. It’s these affairs of the heart that contain the soul of my film. - Ben Mittleman