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Thursday, April 4, 2013

Why Can't You Fix Her?

*Family of a 99 year old woman with slightly more altered mental status than usual is bedside*

Dr. Discharge: Well, all her labs look good.  Urine is clean.  She has a history of Alzheimer's that's been getting worse over the years.  I can't find anything acute going on.  We're going to go ahead and send her back to the nursing home now.

*The nursing home, for once, didn't think she needed to come in but the family insisted*

Family: What about her confusion? 
Dr. Discharge: She's been confused for years and, I hate to break it to you, but she's only going to continue to get worse. 
Family: What about her shaky hands? 
Dr. Discharge: She's had Parkinson's for years. . . 
Family: What about her high blood pressure? 
Dr. Discharge: She's had that for years too and is on medication. 
Family: But it's too high!
Dr. Discharge: It's 140/90.  It's a little elevated, but the doc at the home can take care of a med adjustment.
Family: What about --
Dr. Discharge (giving me the look that he's about to lose patience): Look, there isn't anything going on that hasn't been going on for years.  There's no emergency.  There's no acute illness.  This is an EMERGENCY room.  We can't fix or test for every little thing that is going on.  Unfortunately, there's no magic pill or procedure that's going to fix everything she's got going on.  She's ninety-nine.  She's got to see her primary doc at the home.
*Dr. Discharge walks out*
Family (Great, now their attention is on me): Well, where did he go to medical school?!?!  He's the worst doctor I've ever seen!

Some people have no idea. . .

1 comment:

  1. My typical reply is "Where did *you* go to medical school? Oh...nowhere? Ever?? Then I guess your experience is kind of limited, because trust me, there are FAR worse doctors you've never seen. So since he has 8 years of post-graduate training, board certification, and XX years of experience being a doctor, and you have none, I'ma give him the benefit of the doubt on this one.
    But just remember, there are dozens of worse doctors who'll happily torture your mother with needless tests to no avail until your insurance coverage runs out, at other hospitals all over town. Remember that the next time you want to browbeat the nursing home staff into sending your mom here for a diagnosis of SSDD.
    But since she's a 99-year-old with Alzheimer's dementia, Parkinson's, and high blood pressure, here's a lovely pamphlet to read on making her a DNR, and not bringing her here for anything except acute and easily reversible conditions, like UTIs, lacerations, and fractures.
    And not to put too fine a point on it, but I know a lot of children with relatives who can't care for themselves any more, and usually if they'd spend more time at Gram's bedside every day at the home, they wouldn't be so quick to project the guilt of being neglectful children onto the people who do see her everyday, with each bit of evidence that she's sliding into a casket by inches every time they look. Not that you're like that, though."

    My management team can't figure out why their Press Ganey numbers keep trending down.

    Whereas I can't figure out why, just like the students who were the teacher's nightmare, oblivious family members always have a perfect attendance record at the bedside.