Tuesday, August 10, 2010

Croatian physicians/hospitalists in the United States

How much do you know about the "stranger doctor" (hospitalist) that is treating you in the hospital?

At a minimum, you should know the country from which your hospitalist comes. If the hospitalist was not born and raised in the United States (a country that emphasizes respect, care and charity) then you should learn a bit about the hospitalist's home country and its human rights record.

During my dad's September 2007, Duke University Hospital assigned Dr. Gordana Vlahovic as his hospitalist. Dr. Vlahovic earned her medical degree from the University of Zagreb (Croatia). My dad was 74 years old at the time. His course and quality of care during that hospitalization was necessarily a function of the hospitalist's perceptions of geriatric patients. That perception is developed throughout one's life. For that reason, the hospitalist's home country and background is significant.

How do Croatians and specifically the medical community in Croatia treat the elderly?

My dad was in Duke University Hospital in September 2007 with a urinary tract infection and associated weakness. A couple weeks earlier, my dad was in the Emergency Department with an inability to void. That condition followed a procedure to reduce the size of his prostate.

Dad fell while in his Duke University Hospital room. No medical care professional seemed concerned. Why then did hospitalist Dr. Gordana Vlahovic try feverishly to have me admit dad to a nursing home? Vlahovic: "you (me) have a life too." Me: "the priority right now is my dad-he is my life."

DUH told me that they contacted dad's urologist to examine dad. DUH lied. I contacted the urologist and he came to dad's hospital room. I heard the urologist outside the room as he was checking dad's chart. I heard a DUH nurse question the urologist's authority to read the medical record. The urologist was a Duke physician/surgeon. I was learning quickly that the treating clinic doctors were not welcomed at DUH. The Hospital is the purview of hospitalists (stranger doctors).

The urologist urged me to take dad home that day. He told me that if my dad entered a nursing home, he would be subjected to a urinary catheter. It would be a matter of convenience for the staff. The problem is that the catheter is likely to cause a UTI. And very often the only presenting symptom of a UTI is an altered mental status and confusion. Ah ha. Then the nursing home staff will presume the patient has dementia and the catheter will remain. The UTI will worsen until the kidneys are affected and the patient will die.

What then is it about Croatians and their attitudes about family and aging that would cause a Croatian hospitalist working in a US hospital to recommend that I put my dad in a nursing home so that I can cavalierly go about my life?

Every culture has their own set of values and guiding moral and ethical principles. As a hospital patient or the loved one of a hospital patient, you have the responsibility to know where the hospitalist was born, nurtured and educated. Moving to the United States does not erase those fundamental principles and values from the hospitalist ("stranger doctor").

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