Our practice will no longer see nursing home patients in our office. If a nursing home patient is already established with us, then we will see him; but, we have decided not to accept new patients.
Of course, we believe that these individuals — like the rest of us — deserve medical care. This demographic not only deserves care, but has the greatest need for medical services. Our practice will see every person who wants to see us, including the uninsured.
Why, then, would a welcoming practice like ours close our door to new nursing home patients? We couldn’t take it anymore.
These patients, who often have serious physical and mental challenges, would typically arrive to our office accompanied by a driver, who naturally has no medical knowledge. The patient often had no awareness of the reason for the visit. The ‘medical record’ consisted of a nearly indecipherable list of medications of uncertain accuracy. Typically, no reason for the visit was documented, or there might appear a scrawl — “stomach problems” — not quite a road map that a consulting gastroenterologist can follow. I would then, in the middle of my practice day, call the nursing home in search of a nurse (or nurse’s aide or secretary or janitor) who might enlighten me on what my focus should be. This task is about as fun and efficient as calling the IRS customer service line with a tax question. Often, the nurse who might actually know the reason for the visit is off that day or works a different shift.
It took several years before our practice declared ‘no mas’, but our level of exasperation finally exceeded our patience. Our repeated attempts to improve communications were not successful.
Here’s what didn’t happen:
- The patient’s doctor or nurse would call us in advance to discuss the case so that we might gain information that would make an office visit worthwhile.
- We are contacted in advance, and we advise that a diagnostic test or blood tests be performed before the office visit.
- We are contacted in advance and, after discussing the case, request certain prior medical records to be sent before an office consultation. If a patient is having rectal bleeding, for example, I want to review the prior colonoscopy records. Perhaps, a repeat procedure is not necessary.
- A family member accompanies the patient to the office visit. I am not judging folks here, and family members may live out of town, but I was always surprised that these ailing and elderly patients rarely arrive with a family member who could play a critical role of providing (or obtaining) medical knowledge and advocating for their loved one.
This has been a vexing issue. If you were sending an elderly patient, perhaps demented, to a doctor, why wouldn’t you give that physician a full briefing so that he or she could do a decent job? Even when we are sufficiently informed, the task is challenging. But, we shouldn’t be asked to work blindfolded in the dark.
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
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