Hospitalists and whose minding the store of continuity.

Two days ago I assisted in moving my dear friend, Betty from the hospital to the rehab unit of a nursing home.  Betty will be 84 in April.  After nearly four weeks in the hospital moving Betty was a relief yet, it was a sad day.  The nursing home was the last place she wanted to go.  At her age many people don’t come out and she knows that.  But at the same time, with the care she was receiving in the hospital she was not improving.  So we were glad she was moving, in hopes that she would now receive the care she needed to improve.  Time will tell.

I visited Betty nearly every day.  As a close friend I was added to the list of people who could speak to her doctors and who could call to talk to anyone in the hospital about her case.  From the beginning I was vigilant to ensure there was a continuity to her care.  In the ER I made sure that her current list of meds was entered into the hospital system (the last time when she was discharged we were given a list of meds “she had been on when she was admitted” and the list was inaccurate.  So this time, I made sure that the list in the hospital’s computer was updated.

A week after she moved to her room and was treated for an irregular heart beat which peaked with a heart attack, she was still coughing severely, the main problem she came into the hospital for.  Her breathing was stressed and though her heart issues seemed in control, she was not getting better.  After talking to a good family friend who is a  pulmonary specialist I addressed her doctor, who had no pulmonary specialists to work with as the hospital does not employ one.  He agreed to speak with our friend, then ordered some tests and voila’ discovered that Betty was hyperventilating because she was breathing too fast.  She started to seem better as they coached her in how to slow her breathing down and they gave her some anti-anxiety meds.  Things were moving along and all of a sudden, new symptoms and a new doctor.  Those new symptoms got dealt with and a few days later yet more new symptoms arose and we got yet another new doctor.

In the nearly four weeks Betty was in the hospital she had 5 doctors and two specialists working with her.  The specialists were always the same and while the hospital didn’t have a pulmonary specialist, her heart doctor and hemotologist seemed to know what they were doing.

The most upsetting aspect of Betty’s stay in the hospital wasa the constant change of guard and the seemingly lack of turn over from one doctor to the next.  It was us, me and her family, who were the ones who ensured the continuity of care.

I haven’t gone into all of the details of Betty’s care here – – they were numerous and required many meetings with each new doctor, keeping track of what was happening with and for her all the time she was there. What I am left with after this stint of being with Betty and ensuring, as best I could, the continuity of her care is a new view of what it is to be cared for in a hospital – at least in our local hospital  – and from interviewing doctor friends who work in hospitals, it seems to be something that is happening in all hospitals, at least in NY State.

At one point during Betty’s stay, when the change of guard marked a radical change in care and resulted in Betty not getting some of the meds she had been taking as well as breathing treatments which eased her breathing, I called the administration of the hospital and asked to talk to someone.  It wasn’t a complaint about the individual doctors that I wanted to register but instead a concern about the organizational structure the doctors were working inside of. It seems to me that this type of structure – on for 4 or 5 days then off and another doctor takes over, and when the first doctor comes back he/she is not necessarily reassigned the same patients.  The same with the nurses.  Betty had great nurses but she would have one one day and the next that nurse been moved down the hall to new patients.

I expressed my concern to the person who answered the phone in the Administration Office and a few hours later received a call.  My complaint I was passed on to the head of nurses, which made absolutely no sense to me.  I expressed that and he assured me that he was the right person to talk to however, when I started to speak knowledgeably about what was happening to Betty, he didn’t want to talk to me because the slip of paper which had my name on it showing that I was approved to converse on Betty’s behalf, had been thrown away.

With this dilemma, in front of him, he didn’t hear what I was saying and instead defended the doctors and ultimately hung up on me. Well, I did get a little hot under the collar just before he said “I am not going to have you holler at me, I am hanging up on you now.”   He later apologized (once he discovered the missing piece of paper) and listened to what I was saying and suggested I go to the Doctor in charge of all Hospitalists.

All of the doctors and nurses cared about Betty and wanted to provide the best possible care for her.  I think, however the way in which they are scheduled doesn’t allow for THEM to provide continuity of care.  At best they can write good notes and then when they come on duty with a new patient read the notes the last doctor or nurse left very carefully.  That is something but it isn’t reliable.  People get tired, get stressed and forget things. To turn over critical information about patients is something that requires extraordinary skill – – and the amount of turn over being required by these doctors is an added responsibility which, I believe takes them away from what they are there for – – to care for the patient effectively.  To have an environment which allows for the medical staff to excel and be extraordinary doctors and nurses there needs to be a structure that allows them to do that.  This is not it.

Now the question is, what am I going to do about it?  The system is so big and so entangled that I couldn’t possibly understand it all from here – outside as a friend of a patient.  Saying something is really the only action I can take.  Calling the doctor in charge of the hospitalists is a start.  Perhaps a letter to the editor is another step.  The other thing I can do is research where there is a better hospital to plan for any possible emergencies I or my family might undergo – that is for my own peace of mind.  I could do all of these things.

One step at a time, pressed up against the resignation of being able to truly make a difference in such a large and intricate culture of unworkability.  I can chose to step or I can chose to ignore it.  Well, I guess writing this is a step, isn’t it?  A phone call is not a difficult thing to do.

“Hello, may I speak to Dr. Stellone?”

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3 thoughts on “Hospitalists and whose minding the store of continuity.

  1. Since 2006, nearly all of the doctors I have worked with, many of them very good, overlooked essential information while in the process of making my treatment decisions. When this first began, I was told by my doctors’ staff that they were required to schedule 15 minutes per patient. That provides them very little time to review my file and get up to speed or represence themselves to what they prescribed the last time they saw me and why.

    And when hospitalized in a “good hospital,” my needs have been overlooked or improperly managed. When I was able, I spoke up and when I was not, there was someone advocating for me. What has become clear to me is that as a patient I must vigilantly advocate for myself at all times, never stopping to rest. And when I know I will be heavily medicated, i.e, recovering from surgery, I prepare in advance to have a team of people to advocate for me daily. For those patients who are not able to advocate for themselves, there must be people like you, Shirley, there to advocate for them non-stop without rest…until the system is different from how it is now. Until structures are put in place to maintain the highest levels of effectiveness of doctors, nurses and the hospital staff, fierce advocacy is a must. And this conversation must continue. It’s my understanding that the number of deaths that result from medical error would fill a 747 every day. If there was a 747 crashing every day, we would not stand for it. Thank you for speaking up.

      • You’re welcome and thank you.

        I neglected to mention that each time the doctors overlooked essential info regarding my treatment decisions, my wife or I spoke up and asked questions which resulted in significant changes in the treatment plans.

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