Thursday, May 20, 2010

Is advocating for the elderly worth the effort?

I have not made a lot of friends at Duke University Hospital (DUH) since I began advocating for my dad. And since his death on January 15, 2010, and reading his autopsy, my advocacy has not stopped.

Today a physician in Chicago refused to treat me because "he did not feel comfortable." No other explanation. For a moment, I felt abandoned. I also felt angry because I wondered whether someone at Duke told this physician something negative about me.

The only thing Duke could ever say negative about me is that I was and continue to be a strong advocate for my elderly, frail dad. If the Chicago physician was offended by that and chose to allow me to continue to suffer because I advocate for my dad (and every other patient at Duke), then shame on him. A good physician should never want a human being to suffer.

I would stay in pain for the rest of my life if it meant that someday, somehow my effort to improve the communication system at Duke caused some positive change.

I have tried since 2006 to work within the DUH system and I have assured DUH that I am *not* their adversary. I am their advocate too.

The Duke Medical System involves various different organizations.

1. Duke University Hospital - employs hospitalists and utilizes less experienced clinicians at Duke Clinics (formerly known as Private Diagnostic Clinic) as hospitalists for short percentages of time.

The Duke Clinic physicians and surgeons are not permitted to control the care of their patient when in-house at DUH. That is significant in two ways: (a) the physicians can recommend the patient be hospitalized to receive, as with my dad, three days of IV antibiotics; but the hospitalist can simply ignore the treaters' recommendation without communicating the refusal to the treater; and (b) the patient can present through the ED and DUH has no procedure to inform, much less request background information, from the patient's current Duke Clinic treaters.

The most significant reversals in my dad's health occurred when dad was in-house at DUH. Hospitalists refused to communicate with dad's oncologist because additional about the patient would "muddy the water." Hospitalists completely ignored dad's treating orthopedic surgeon and oncologist. The former nearly lead to dad's foot being amputated.

The cutest part was when a FMG hospitalist (who clearly did not understand our culture) recommended that dad be placed in a nursing home as opposed to me devoting my life to his care. Why? Did dad did specialized medical care? No. The hospitalist told me "you have a life too.

The Duke administration will throw its Duke Clinic physicians and surgeons under the bus to protect the hospitalists. That part I do not get. But I will get it someday.

2. Duke Hospital in Raleigh - presumably connected to DUH but there is no cooperation, communication or coordination with the physicians in Durham.

3. Duke billing and clerical - I am not clear what corporation technically employs these individuals. But I have been told by heads of Duke Medical School departments that they would only accept a clinical position at Duke if they could be assured that all billing and clerical work would be performed by individuals that the physicians could discipline, hire, fire.

If the Duke Clinic physician or surgeon cannot discipline his or her administrative assistant, PA, nurse, clerical, then one must wonder precisely where the para-professionals' loyalty is placed.

In order for the surgeon or physician to work at his or her clinical best (not to mention professional research, writing), the physician must have the cooperation and loyalty of the staff. It seems a basic. It is not a basic at Duke Medical.

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