Tuesday, June 9, 2009

Oprah's support of Hospitalist Program Model is uninformed & wrong

Sorry Oprah but you (and the well-respected Dr. Oz) are just plain wrong on this one. Hospitalists are not a part of the medical system to ensure good medical care.

In fact, at least at Duke University Hospital (DUH), the hospitalists endanger patients' lives and even have (in my knowledge) been responsible for at least two (2) patient deaths within the last year because the hospitalists refuse to communicate with Duke Clinic doctors (and the hospitalists were misinformed about the patients' diabetic statuses in both cases).


My dad has been a patient of Duke University Hospital in Durham NC. And each and every time my dad is admitted, the DUH hospitalists literally refused to cooperate, communicate or coordinate with dad's treating Duke Clinic surgeons, oncologists. And in most cases, it is those treating Duke doctors that admit dad to DUH.

Read my blog and you will learn of the inherent dangers of "stranger doctors" treating you in the hospital. The situation with my dad has resulted in actual (as opposed to academic) dangers.

Two of the most traumatic events for my dad:


1. In November 2007, my dad had a horrible skin infection as a side effect of chemotherapy (dad is 76 years old). Dad's Duke Clinic oncologist (Dr. Michael Morse - a terrific physician and man) wanted dad in DUH for 3 days of IV antibiotics.

We arrived at DUH and the hospitalist (Dr. Hope Uronis) kept dad in a DUH room for 3 days but told me (via telephone) that she saw no reason for antibiotics.

Dr. Hope Uronis flatly refused the Duke Clinic oncologist's orders and refused to give dad any antibiotics whatsoever. No IV antibiotic. No antibiotic oral medications - not even an antibiotic cream.

My dad's skin sores oozed and smelled terribly foul. No one from DUH even changed the dressing!


Dad was discharged in great pain. There was no plan for pain control, no plan for wound management and no follow-up appointments.

Four days after that discharge, dad was readmitted to the hospital with serious pneumonia! Dad almost died.


2. In August 2008, Dad was admitted to DUH because of infections related to chemotherapy. I begged (literally) the hospitalist Dr. Veshana Ramiah to contact the Duke Clinic oncologist and Duke Clinic orthopedic surgeon.

One of the mot serious (and smelly) sores was at the site of the foot surgery. I explained to the hospitalist that dad had recently undergone foot surgery by a Duke orthopedic surgeon.

Dr. Veshana Ramiah flatly told me that she refused to communicate with the Duke Clinic docs because she was in charge.


After 2 weeks at DUH, my dad was discharged via ambulance because his foot was so infected and painful that he could not walk. In fact dad was so ill that he could not even sit up on his own.

There was no plan for pain management. There was no plan for wound management. And, as per usual at DUH, there were no discharge follow up appointments.

At the encouragement of dad's Duke PT, I took dad back to the Duke Clinic orthopedic surgeon in November 2008. Five surgeries later, we are still hopeful that dad does not lose his foot.


Because the hospitalist (Dr. Veshana Ramiah) was so turf oriented and egotistical, that she ignored the obvious need for an orthopedic consult in August 2008. Dad had metal in his foot and the infection was deep into the metal.

All it would have taken is for DUH hospitalist (Dr. Veshana Ramiah) to communicate with the Duke Clinic doctors. But Dr. Ramiah told me that her sole purpose as a hospitalist is to save the hospital money. Hospitalists are trained to triage the patient (and thereby consider the patient's medical condition like a snap shot rather than a movie).

In fact, during a 3-week hospitalization in November where Duke orthopedic surgeon (Dr. Mark Easley) courageously and skillfully saved my dad's foot, Dr. Easley ordered a urinalysis (as opposed to the cheaper dip stick version) to make sure dad did not have an infection.

I am unclear about his status and whether he was technically a
"hospitalist" - but a 1st year orthopedic resident actually told me to my face that he did not have to follow the treating orthopedic surgeon's directions for urine cultures. According to the hospitalist/resident, a dip stick was cheaper and (I kid you not) this guy told me that as a hospitalist, his job was to save the hospital money. Period. The hospitalist/resident flatly told me that he does not have to follow Dr. Easley's orders.

I took dad directly to his non-Duke urologist. Dad had a raging UTI. Apparently men with enlarged prostates and who have been cathed for a long time are very prone to UTI. And, the urine dip stick/quick test did in fact show negative for the urologist also.

According to the Duke trained urologist, the quick test often shows false negatives for elderly men with enlarged prostates and clinical history of repeated cath related UTIs.

Shame on the hospitalists at DUH.

The problem with the Hospitalist Program Model is that there is absolutely no standardization in the program. One program could be great and then there is DUH!

We deserve more than stranger doctors dictating our medical care and our lives, Oprah and Dr. Oz.

IMHO, it seems that the whole point of the Hospitalist Program Model is to ready us for federal medical board (equivalent to federal reserve board) rationing care and important medical decisions to be made for us by "strangers."


Doctors and surgeons are going to lose control of their professional if Obama wins.

STOP the Hospitalist Program Model. Please.

_________

I put my life on hold to care for my dad. I do not want my dad in a nursing home. That is not what a family should do. I am my dad's advocate and care-giver. My mom runs her own business so that we can afford health insurance, medicines and food.

Although I am blessed to have this opportunity to care for dad, it has not come without crushing disappointments. Many of my readers understand the sacrifices made when you choose to care for a vulnerable person. I hope that my blog encourages you through my surviving similar experiences. Remember that the most important person is the person who needs care.

My brother and maternal uncle do not understand the stress I endure protecting my dad.


My brother ignores and insults me and my maternal uncle did not even invite me to his daughter (my cousin's) wedding. But I am not so sad about my family ignoring me. My dad's life is more important than being invited to a wedding.

The saddest part is that my advocating for my dad has split my family apart.


These members of my family think I should just let the doctors do what they want and I should be polite with the doctors. But I think my dad (and all elderly persons) deserve dignity and respect in medical care. Sadly, an non-standardized Hospitalist Program Model jeopardizes the health and safety of our citizens.

Interestingly, no study has ever been done on the Hospitalist Program Model to learn whether
(1) patients are subjected to quick re-admissions
(2) patients are satisfied and
(3) patients are benefited.


The only Hospitalist Program Model studies have been on whether the programs save hospitals money. And it is true that the Model does save money. The hospital admissions are reduced . . . but are the patients re-admitted more ill or dead?

http://www.oprah.com/article/oprahshow/20090219-tows-smart-patient/8

1 comment:

  1. As patient advocates you must demand to be treated by ur own doc - not a guy like this. Egotistical & cannot accept the program has no standardization. I will fight & educate people until we are no longer forced to be treated by stranger docs who care only about saving $.

    No to an mon-standardized hospitalist program model - they save $ but cost lives!

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