I live in Maryland, and many of our doctors have retired, or just left, because of paperwork. They are being replaced by Physician's Assistants or Nurse Practitioners. I have a real problem with my husband since he was very attached to his Primary Care Physician, considered her a friend, and trusted her implicitly. When she retired very abruptly (I thought she was 10 years younger), we were assigned a PA. I took him to her several times as his foot was swelling and a sore was developing on his heel. She sent him for xrays and tests and finally the office said I could not get another emergency appt with the PA because he had already had two emergency appts. So I took him to the ER. They hospitalized him for a severe infection that went down to the bone. They could not find a hospital bed for him; had to send him far out of our region. I liked the dr. there, and I told him about all the concerns I had about him, mostly cognitive and radical behavior changes, which I thought might be due to a UTI. That dr. said he would give my husband a thorough examination, but when I went the next day, the doctor said my husband was being released. He has to see four specialists now, and all of the appts are weeks and months away. Thank God for the home nurse, who changes his dressings and is the only one who gives me straight answers. Today he finishes up his antibiotic pills that he received at the hospital but it is still 10 days before he can see the PA (who I really blame for his having to go to emergency room in the first place), and I have had no help with his behavior changes and he is hallucinating a lot. I am very frightened to be left alone with him. I feel that the whole medical profession has been ruined. This is basically a vent. Thanks for listening.
You can refuse to sign for discharge, citing the fact that he is a danger to himself and others if he is still actively hallucinating.
Me, I'd call 911 again and have him re-admitted.
Just before my LO was diagnosed with dementia, her very competent and attentive physician, who was a nephrologist by specialty but practiced very actively within the geriatric population, had also resigned, but just by luck, LO had almost immediately become attached to a geriatric practice of whom her original physician wholeheartedly approved.
then less than a year later, when she entered assisted living, I requested the doctor on staff there to be her doctor of record, and again, a wonderful match, and again, just sheer luck.
Are you considering another search for a geriatric specialist for your husband? In my state, not too far from yours, it seems to work best when someone has an umbrella oversight of the patient’s care.
My LO also has a rather complicated but so far VERY EFFECTIVE insurance plan, and it seems to support most (perhaps all) of the recommendations that are made for her needs.
If you have confidence in your “home nurse”, would it be worth asking her if she knew of any comprehensive geriatric practices near enough to you where your husband might have a chance to be seen sooner?
Your situation reminds me of some similar episodes while I was taking care of my mother.
My mother didn’t like doctors, and until she had a stroke at 85, simply never went to them. NEVER.
When she needed complex specialized help, there wasn’t any one for us to take her to.
Feel comfortable ranting. There’s ALWAYS somebody here who will listen.
http://canhr.org/factsheets/resrights_fs/html/fs_challengingdischarge.htm
It is only going to get worse.
We actually already have socialized medicine, we just pay personally for the crappy system it has become.
My husband has left messages with several of his docs with no call backs - luckily nothing urgent - I keep telling him to use the portal - I seem to get a faster response on that. In fact I need to re-contact one of his docs for a referral.
Good luck and keep on them.
Another problem is hospitalization itself--especially for patients with dementia, they can become delirious and they never recover from that. On the other hand, if the infection became RESISTANT to the antibiotics OR caught a hospital-acquired infection on top of his existing one he probably will need to be hospitalized again. With COVID running rampant he is in a terrible situation.
Oral medications are not enough when it comes to sepsis or blood infection. Antibiotics has its own risks including c-diff diarrhea and can impact the heart conduction system.
Behavior changes and hallucinations are not normal--he probably needs to go back to the emergency room. They need to reculture his blood, wound, urine and do follow up x-rays. and do fresh labs to see his kidney and liver status as well. If he has kidney or liver issues that too can cause behavior changes. EVERYTHING needs to be looked at in my opinion only. Who knows what is going on...he may even be dehydrated. But if he has underlying enlarged heart you have to be careful with fluids. Yes it is a mess you have to deal with.
The patient needs to be touched, seen, listened to, smelt, all the senses go into diagnosis.
Some years ago, my uncle, living in a rural area of central Pennsylvania, suffered a stroke. He needed to have physical therapy, but because of the convoluted system, there was some sort of "window" during which it had to be scheduled, but because he never received any definitive information on this, the opportunity was missed, and he spent the rest of his life in a wheelchair, mostly paralyzed on one side.
A few days ago, I saw an article rating medical care in 11 western countries, and unfortunately for many of us here, the US was #11.
NO ONE should do a zoom doctors appointment. They cannot palpate a wound, check blood pressure, hear a lung fill up with air, nor smell the patient. all of which are needed for a diagnosis.
And while I've had to use PAs before, I found that they are basically useless and nowhere near "almost a doctor". The Nurses have been far more intelligent and listening to the symptoms actually helped with diagnosis and information of which doctor to see (outside the PAs hearing)
I'm a member of a menopause support group and lately we've been talking about medical tourism to Mexico including visiting the dentist. And I am NOT kidding! At least in Mexico there still is a physician medical ethos and prices are reasonable.
Also, my best friend's dad is a retired board certified internal medicine physician from New York City. He now lives in Florida and is scared to death of getting sick and being hospitalized and this was pre-pandemic. Toward the end of his career - and he practiced until he was 70 something - he hated being a physician.
He told me that after he affiliated with the big hospital system in his area, the hospital's bean counters told him how to run his practice, how extra inundated he became by paperwork from insurance companies and the hospital's compliance team, they took away two of his nurses and tried to force him to accept a PA, etc etc etc. He wanted to stop accepting new patients because he felt he didn't have enough time to see his existing patients let alone take on new ones. He was overruled and his patient load increased. A scheduler was hired to schedule patients into 8-minute slots, spy on him, and track his "productivity".
When hospitalized, his patients were taken over by the hospitalists, who frequently messed up their medications because they didn't bother to call him even though his patients asked them to call him because he was their PCP.
America's healthcare system isn't healthy nor caring nor a system. Walter Cronkite said that. It started getting bad in the 1980s, has only gotten worse since, and it's going off the cliff.
And cetude I agree with you except for "...It is not the medical profession but overpopulation..." It's both! Like many people, doctors were too timid to stand up for themselves. Now they're getting a taste of what other people who've been outsourced or downsized have been experiencing for decades.
I find the PA's and nurse practitioners poorly trained and with limited knowledge. They do not have what it takes to make an informed diagnosis. They are no substitutes for doctors. They make guesses, but simply do not have the education to make a real diagnosis in ER or broad intake situations. They have sketchy knowledge about the most usual presentations of the most common illnesses but absolutely no clue about unusual presentations or even slightly rare conditions. I am not faulting the individuals who do these jobs; they are expected to do the job of a doctor with 4 years of medical school and several years of internship and residency requirements but may only have a 2 year certificate with considerably less rigorous requirements. There simply is no comparison between a PA and a real doctor.
It is time to get rid of the medicine-for-profit model. It has failed us utterly. Perhaps it is also time to fully fund medical school for qualified candidates and increase the number of fully qualified doctors to a number equal to that required. In the last year I have seen the number of doctors and RNs in our local hospitals and clinics decrease as the for-profit institutions lay them off and bring in cheaper PAs and cna's to do the work more cheaply. Then they raise the price they charge us to keep up the profits while we are deprived decent care.
Maybe try to se a podiatrist but, please do not let this go. A foot injury can be deadly.
A person isn't supposed to have a uti for weeks or months without being treated. Thats rediculious!
In the mean time you need to find a geriatric primary doctor.
I would get him there asap. Don't say you have been to other docs and they did nothing. Don't mention anyone or anything. If they ask about his last doc, she retired abruptly. That's all you know. Don't offer anything about his appts, or the PA not diagnosing properly etc. Nothing. Get him there Pronto. Good luck.
If you feel unsafe and he is hallucinating, I would take him right back to the ER. They should admit him until he is stabilized. I am sorry you are going through this!
If they can not give you the appointment, it may be time to shop for a new doctor. I would urge you to find a doctor that specializes in internal medicine rather than family medicine. If you can get one that specializes in geriatrics, that would be best. Look for a group practice that has several medical doctors and less NPs or PAs, since that is your preference and you have more opportunities seeing a medical doctor for any problem.
As for the current situation, I expect the hospital set your husband up with several specialist appointments because he has multiple problems that need to be addressed. Orthopedics or podiatry for foot. Maybe cardiovascular for the foot as well. Neurology for the hallucinations and behavior changes.
If you feel unsafe with your husband at any time, take him to the ER or call 911. You and he should be cared for in ways that keep both of you healthy and safe.
Once when I had my mom in a respected hospital ICU, I was told by her surgeon that I better get mom home (he discharged her from ICU to home - warning that the night nurses there were very difficult - he even said that he thought if mom stayed in the ICU that night he feared she wouldn’t make it through the night.
Don’t settle for anyone who is not an MD.
If you live in the DC area send me a private message - I could recommend a practice where we have received excellent care.
if he is on a few different medications, chart them out to see if they could be causing confusion. That happened to us.
Look for side effects and warnings of negative interactions. The pharmacy print outs will be a good place to start.
You can’t take him off meds without a doctors supervision - some must be tapered.
Google is my diagnostic then I call the appropriate physician, and make an appointment.
I had an issue with an ENT’s medical assistant.
She acted like a “barium swallow”needed approval and it doesn’t.
The ENT heard her scaring me, that it “might not get approved,” and he hollered at her from his office. (The door was open)
She did nothing for 8 days!
I called United Healthcare crying and they put me on hold and called the office, twice. Nobody picked up so they left (2) voicemails on my behalf.
I didn’t know they did that.
That vindictive medical assistant, “ghosted” me out of spite, delaying my dysphasia condition.
UHC called back 2 days later and they filed a complaint against the “staff.” They were VERY angry.
Why would someone be so reckless and nasty to a choking (literally) person?
My “primary” got involved when nobody would answer the phone.
What a nightmare over a test.
I finally got it 2 days after all those calls.
I find Walk in clinics to be very thorough, available and attentive.
Find comfort knowing it’s not just happening to you.
Hugs to all struggling to get an appointment. 🤗
Be vigilant and verbalize your distress. 🗣 🚨