Friday, April 06, 2012

Ups and downs

I wrote a couple of posts ago about the passing of my mother. Before I forget, a few quick thoughts about what happened in terms of health care in her final days might be instructive. It was my first time through the process, and there was good news and bad news.

Mom had gone in for dialysis when a problem with her port was discovered. She was sent to a hospital for treatment and possible surgery. Fine. Some days later, the good people at dialysis noticed that Mom hadn't made her usual appointment and wondered what was up. So a staff member called the hospital to act.

A nurse there told the dialysis clinic that Mom was refusing treatment, food and water. That was a shock, so the worker called my sister and asked if the hospital had called to tell her. No, so my sister called me and delivered the same shock. In hindsight, I was a bit surprised that such an action didn't set off alarm bells all over the health care system. I suppose we would have found out something eventually, but it sure seemed like someone dropped the ball.

On the other hand, big credit goes to the dialysis clinic for taking action.

I had asked to speak with a social worker about the situation, in order to fulfill my mother's wishes. One eventually called a couple of days later, but she was amazingly clueless. She told me about plans for Mom's discharge, and that plans for physical therapy were recommended for my mother. I found that stunning.

Upon arrival in Florida, my sister and I smoothed out the transfer of Mom to a hospice. The people were there were absolutely terrific, making it as good an experience as possible. I must make a contribution when everything settles down.

Still, there was one last surprise the next day. I discovered the primary care physician knew nothing about the situation until his office received a fax about her death that morning. In fact, a nurse had been trying to track her down for a while.

Our health care system is big, and I expect things to fall through the cracks or act less than logically. Still, I'll try to remember that there are people that care, and care deeply, all along the way.

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Jeff Hodge said...

I think many (most?) of us see this in our own health care. The idea of "primary care physician" to coordinate your care just doesn't work. We all have to take charge facilitating the communications between a specialist, our PCP, the pharmacy, etc. In the passing of my Dad, my Mom (age 83) had to follow up with the several doctors and hospital and relay communications between them all. Fortunately, when my Dad returned to the assisted-living facilities at their residence, the folks there were excellent in coordinating things like insurance. He had some very caring and personable health care providers then. But you're right. It's a big system and you are on your own at times.

Jane Bailey Pyszczynski said...

The complexity of the system really requires that there is someone beyond the patient tracking everything. When the family members are out of town (as Budd and I are), it is even more difficult. Because beds were full at Mom's "usual" hospital, she was less visible without her doctor of 20+ years. I work for the American Academy of Family Physicians, and we spend a significant time on this issue, a patient-centered medical home. It's a tough battle within a complicated system!