My Visit to the Doctor's Office

By Hootsbuddy

Let me tell you about my grandchildren, vacation, mother-in-law, nasty boss, stupid neighbor, trip to the doctor. I promise not to go on too long or bore you with details but this will take a few minutes. 

My reason for writing this up is two-fold. First, my recent personal experiences with health care in America are related to the public debate as much as anyone else's. And second, that same public debate is morphing from a debate to an emotional tsunami standing in the way of progress.

Mom's Story

My late mother began losing her short-term memory as she got older, so my sister and I decided that after living along for several years following my father's death,  Mom no longer should be driving and living alone. So my wife and I moved to a larger house where my wife became her principle care giver for two years. (Any reader unaware of how truly demanding that job is should do more reading to prepare for your turn.) At that time my wife said, "Okay. I did that. It's now up to you and your sister to take care of Mom."

We were blessed to have had two years for the next move, because it made it easier to move Mom into an assisted living arrangement with her own apartment, furniture, personal effects, kitchen and access to a cafeteria in the same building. Professional (non-medical) care givers were available, paid as little as 15-minute intervals, for incidental attention such as excorting Mom and other residents to meals, games, outings, church and other planned activities. Mom was very comfortable and happy in that environment and looked forward to weekly visits from me and my sister. We took care of her small needs (laundry, shopping) and outings to our houses for holidays and other events. 

This is the part of the story that gets interesting. Unfortunately on Thanksgiving, 2007 Mom fell while making her bed. She was very independent and did everything for herself, but EMTs were called and she was taken to the nearest hospital for treatment. Why did she fall? Did she trip or have a stroke? Were other bones broken? Could there be internal bleeding? Answers to these questions would have to wait because the hospital decided that she failed to meet the criteria for admission, so her arm was put in a sling and she was sent home with my sister.

Taking her back to her apartment was out of the question. She could no longer get dressed, feed herself, go to the toilet, or any of the other ADL ("activities of daily living" -- that's an acronym I picked up in gerontology class). So my sister was panic-stricken as well she should be. They had no way to care for Mom, so with no alternative available and numerous desperate calls to other hospitals who were just as cold-blooded in their refusal to accept her, I brought Mom back to our house with the intention, all other plans failing, to care for her again in the room where she once had lived.

I should add at this point that we all knew that the appropriate place for Mom to be at this point was in a skilled nursing facility, otherwise known as a nursing home. The problem was simple. None of us had the resources to pay the sixty-five or seventy thousand dollars a year for that kind of care, and Mom had no assets. The only way that Medicare would pay for a skilled nursing facility, even for rehabilitation following a disabling medical event,  is that she must first be three days in a hospital, then be discharged on a doctor's order to the facility. If someone is private pay, they might get a bed if one is available, but Medicare will not pay anything more than the medical part of the expenses. I put up a post about it soon after this trauma with details for the reader who wants to know more. 

During mom's two year stay at the senior apartments facility, they advised us that she should be checked for the onset of dementia. She had not done well on what is commonly called a "mini-mental;" a short memory test commonly used to determine mental acuity, especially in seniors (easy questions about what day is it, what would you do if the fire alarm went off, count backward by fours from a hundred, etc). At that time she went to an excellent hospital specializing in senior care connected with a well-known university. She was found to be in generally good health for her age (88 at the time) and was advised to continue a daily vitamin supplement. She took no other prescription medications. 

I contacted the doctor who had seen her the year before for the evaluation and she asked me some questions about what was going on. I told her the story, adding that since the fall Mom was not able to sleep more than about fifteen or twenty minutes at a time, she was moving around in the bed, pulling the sheets up and down, and wanting to get up to pee whenever she woke up, although she had just been to the toilet less than 30 minutes earlier. At this point, this kind of behavior and similar disorientation had been going on since her fall, now three or four days earlier.The doctor said it sounded like she had delirium and she needed to go to a hospital for that.

I called two other hospitals and found that no one had ever heard of delirium as a reason to be hospitalized, so I called the other doctor back. She said to being Mom into town and she would admit her to the hospital where she was affiliated. I did so and Mom was admitted with the diagnosis of delirium, and after three days was discharged to an excellent nursing home convenient to my work. There is more to the story, but it's not important to this post. .

NPR's Report This Morning on Delirium

As I was driving to my appointment this morning for an echo-cardiogram and Stress test, I heard a story on NPR that caught my attention. Here we are a year and a half after my traumatic experience with Mom and I learn that not only is delirium a proper diagnosis (at the time I thought the doctor was just being uncommonly cooperative and breaking a rule or two, knowing the protocol to get old people into nursing homes) but it is still not widely known about.

...there are precautions a patient's family can take. Family members can start by becoming more aware of the drugs that cause delirium, says geriatrician Malaz Boustani at Indiana University School of Medicine.

One class of medications that can be a big trigger is anti-cholinergic medications or common prescription and over-the-counter drugs such as some sleeping pills, asthma medications and antidepressants

It's also important for older patients in the hospital to keep using their eyeglasses and hearing aids and be allowed to sleep through the night, says Boustani. Delirium can be triggered by a state of confusion, and these things help maintain a more consistent environment.

Boustani recently studied 1,000 senior citizens who came to an Indianapolis hospital. One-third developed delirium. And those who spent more time in the hospital had a higher risk of going to a nursing home or of dying.

Doctors often dismiss delirium, Boustani says, because they think it's just dementia in older people. The two are different. Delirium is a temporary form of cognitive impairment, whereas dementia is a more long-term problem that involves issues with at least two brain functions, such as memory loss along with impaired judgment or language.

Still, there's a link between dementia and delirium.

More fascinating details at the link (the report is only about four minutes long for those who want to listen)

But the punch line of this shaggy dog story is this. Medical information in America seems to travel veeery slooowly  in the medical community unless there is money on the table. In fact, there seem to be barriers to sharing information within the medical community (I use the word advisedly) unless money IS involved. Take a look at this snip from teh DVD version of Maggie Mahar's excellent and comprehensive Money-Driven Medicine. Pay attention half way through at what happens when a doctor at one hospital tries to learn how another hospital appears to be getting better outcomes treating a particular medical problem..

This doesn't explain why no one wanted to admit my Mom to the hospital with a broken arm, even overnight (which in my mind should be considered criminal negligence), but it illustrates how slowly information regarding the delirium diagnosis has been disseminated. The doctor who made the diagnosis a newly graduated so she was in a position to have the latest information. But it could not have been a secret before that. Prior to being taught school, or at least before the information was published in peer-reviewed journals, surely the diagnosis cannot still be called "cutting edge" or "experimental." What ever happened to humanity and common sense?

Now For the Fun Part

When my wife and I graduated to Medicare, we selected an excellent medical practice located less than a mile from where we live as our primary care facility. She likes the doctor who cared for Mom when she lived here and another of the principals (my doctor) comes very highly recommended by a couple we know. And I was totally impressed on one of Mom's visits that their orthopedic man is a spry and very young eighty-plus gentleman, still practicing with an old-school bedside manner as rare now as drive-in movies.

On previous occasions I noticed that the always-on TV in the waiting room was always tuned to Fox News. I'm sorry to report that in this part of the country that is not only unsurprising but it would be a violation of local tastes if it were tuned to any other news source. 

I won't bore you with the details of the tests. That's not the fun part. (The worst part of the stress test was getting my skin spot-shaved and rubbed with sandpaper in preparation for those electrode things they stick on you.) What I could not help (or escape) noticing was that Fox News was all over the place. In addition to the TV in the waiting room, there was another one at the waiting area for "Diagnostics." Another was playing in the little room for those of us waiting between the intervals needed for the echo and stress tests. I was there the better part of four and a half hours and had to listen to that one channel the entire time.

I don't have to tell you what I heard. A steady drumbeat of fair and balanced news all aimed at underscoring a national outbreak of embarrassing behavior all over the country. I got to see and hear Michelle Malkin and other fair and balanced commentators adding their rich and informed analysis to the spreading wildfire aimed at blocking and destroying even civil discussions of H.R.3200. I saw the same images of that guy with his son in a wheel chair yelling and gesturing at his representative. That was repeated, it seems, about five or six times an hour, along with the same dramatic scenes of people yelling, shaking fists and rising in standing ovation at raucous meetings all over the country. I got to see a report comparing the hand-made protest signs of everyday people compared with the professionally printed signs of those supporting the legislation. This is to illustrate the spontaneous nature of the outrage, minimized at least four or five times by the same footage of Kentucky's Senator Mitchell blowing it all off as no more than ordinary people exercising their First Amendment rights.

I almost forgot. Everyone needs to know that Nancy Pelosi calls these good people "unAmerican." We can't forget that because the father of the guy in the wheel chair has now been found and given air time to underscore the point that his representative was not wanting to hear when the cameras were rolling the first time. And some kinda way whatever the context of Pelosi's remark was is forever lost,  having been coupled by Fox fair and balanced News into yet another easy to remember story to be passed along the gossip which feeds the flames of an already burning fire.

Got that?

And as I listened and watched, I was paying attention to the commercials as well as the non-story tidbits used to punctuate this endless anti-H.R.3200 propaganda stream. There was intermittent footage keeping up with the plane crash in the Hudson, some other updates on the war in Afghanistan, and some cute stories about dogs and stuff. But the overall theme could not be missed. I don't know about the rest of the day's schedule, but I can report that this morning's Fox News had essentially one theme.As the chant goes, "Kill The Bill." (Wasn't there a movie title kinda like that?)

And to break the monotony I started keeping track of the commercials. I didn't take notes, and I did spend some time in testing. But the better part of four and a half hours I could watch TV. I can report that during all that time I saw one commercial for some kind of dust mop and another for dog food. With those two exceptions all the rest that I saw were for various kind of insurance, drugs or some combination of both. ("Medicare usually pays for this. We will even file the paperwork for you." I can't recall if this was a drug or medical hardware. It may have been for home health service via an insurance plan.)

Folks, it is not surprising that America's drug and insurance companies are Fox News sponsors. Like all companies they are into marketing and probably advertise on all available channels. But I looked and failed to find the usual annoying assortment of commercial messaged. I didn't hear anything marketing new movie releases, soap, fitness plans, cosmetics, fast foods, automobiles, or any of the endless variety of sponsors one normally hears on TV. With those two exceptions, dog food and dust mops, it was end to end drugs and/or insurance. What does that tell you?

I hope there is no need to connect the two dots in my long post: how disconnected and money-driven is the status quo. And how determined special interests are to block specific legislation during the summer break. This is a time when our Legislative branch should be reporting back to constituents what they have been doing. Instead the public has been frightened and angered by a scripted litany of lies, distortions and willful emotions calculated to torpedo the legislative process at its most vulnerable time. A critical mass of the public no longer wants to listen They only want to yell, shake fists and show contempt for their representatives. Too many minds are already made up. Don't confuse them with facts.

And they say that mobs are spontaneous.

Give. Me. A. Break.