A hospitalist-induced nightmare

Three years ago in Hooray for Hospitalists I described how a good hospitalist program works and how common problems can be avoided through the use of call centers and well-developed and implemented protocols. Today I received a disturbing comment from Eleanor, that I thought deserved to be featured as a main post. Here it is:

Hospitalists caring for my elderly mother never contacted her PCP to find out why he admitted her (to come off Coumadin so that a test of ascites fluid could be done). Instead they doubled her dosage of Lasix and kept her on Coumadin for 5 days hoping that the ascites would “go away.” It took five days of leaving messages before I could find one to talk to, and I demanded that he call her PCP. Finally he did call the PCP, took her off Coumadin and did the test. She was so weak from the 12-day hospitalization (PCP said it would be “three or four days”) that she had to go to a short-term rehab facility. Hospitalists had taken her off Coumadin so didn’t put Coumadin on the list of her meds when she was transferred to the rehab facility. Took me three days to realize she wasn’t getting it and to get her back on it. Hospitalists could not put her back on it because she had been released from the hospital. Rehab’s attending physician could not do it because she had no medical history indicating a need for Coumadin. PCP had no authority at hospital or at rehab center. Unbelievable! Hospitalists wouldn’t talk to me (health care proxy) because Mom was “lucid.” But she is also blind and almost deaf so their explanations of proposed treatment were useless. She was never an “informed patient” and never gave “informed consent” to anything. She was terrified, and I was, too.

Another story: A friend’s elderly husband had chronic diarrhea and incontinence for many months. When he was admitted to an ER for a possible stroke, the hospitalists put him on a prescription-dose of laxatives. Laxatives? For a possible stroke?? In a patient with chronic bowel problems? What were they thinking? Who are these people? Where are they trained? The theory of hospitalists may be excellent, but we need educated, competent, “common sense” physicians filling that role. Those are qualities that the family PCP brings to patient care and they’re sadly lacking with the hospitalists we’ve encountered so far.

These are pretty bad situations. I wish the solution were as simple as banning hospitalists. Unfortunately I’ve heard similar stories about hospitals that don’t involve hospitalists, and not every PCP is as responsive, useful and competent as we might like. As I’ve said before: Going to the Hospital? BYOMD.

September 29, 2009

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