End-of-Life, Healthcare

Doctor on Doctor Crime

Her heart was failing; her ejection fraction was unmeasurable. Her hip was broken, and she developed a pulmonary embolism post-operatively. She was painfully close to death. Yet at some point, the hospital finished, and spit her out at the nursing home.

She was confused.

I tried to take the best history that I could. Her answers where usually no more than a single word. Her physical exam revealed a desperately weak woman, swollen from head to toe. Fluid seeped out of the wounds and lacerations on her legs.

I hopefully clung to the one positive portion of her assessment, it appeared that her pneumonia had cleared. I wrote my admitting note and placed a few orders. Forty-eight hours later, her nurse called to report a low-grade fever. I dragged myself out of a deep sleep on a Sunday morning, and came to her bedside. Her exam was unchanged, all catheters were clean, there was no rash. Her lungs were clear and she had no new complaints. The temperature remained a hair below one-hundred, so I sent for a chest X-ray and urine culture.

The next morning as I reviewed the labs, my mobile rung once again. She was confused and agitated. Her blood pressure was unmeasurable and her heart rate was high. An ambulance was summoned to take her to the hospital.

A few days later, I received a call from her cardiologist. We had never met before, and he introduced himself quickly before cutting to the chase. He wanted to know why I let his patient get so sick. She was doing poorly, and had to be put on hospice. He commented on how she was fine when he discharged her from the hospital. Why had we not treated her fever with antibiotics? His smugness brimmed as he probed further,

How can we make sure this doesn’t happen again?

I was completely taken aback by his questioning. Surely he must have known how sick his patient was. There is no denying the mortality for an elderly person, in severe heart failure, with a broken hip (and a pulmonary embolism and pneumonia) is incredibly high. He also likely understood that one generally doesn’t treat a low-grade fever without identifying a cause.

His diatribe was not a rational discourse on clinical care. It was a witch hunt. He was frustrated that his patient was dying, and he was out for blood from the physician he believed delivered sub-par care.

As I felt the pulse explode in my head, I took a deep breath. Then I thanked him for his phone call and hung up.

I felt horrible for a time. I wished our patient could have survived. I painstakingly re-evaluated each decision. I gave myself credit for some and not so much for others. Eventually the pain abated because it had to. Not because the tragedy had become any less, but more in order to continue to provide the best care possible to those who remain.

But I didn’t decry the accusations as toxic as they may have been. I didn’t try to protect myself from the venom or shield my skin from the burn. I didn’t jab or parry.

Because the other side of the pendulum is the repugnant physician who lacks insight into his own shortcomings, and believes too heavily in his own righteousness. He blames his patients. He blames other physicians.

He often does more harm than good.

And I don’t want to ever become like that.

by Dr. Jordan Grumet- Internal Medicine
*Re-posted with permission. Original can be found at: http://jordan-inmyhumbleopinion.blogspot.ca/2015/01/doctor-on-doctor-crime.html
Aging/Gerontology, Social Work/Helping Profession/Mental Health, Videos

Elder Abuse

by Victoria Brewster, MSW

Elder Abuse: A topic many do not want to think about, but unfortunately it is a reality.
Take a look at the video below and give me your thoughts. The video is educational, worth watching and a great teaching tool. Share it with others.

http://www.youtube.com/watch?v=s_LG3EtcFco&feature=share&list=PL6114E161CE0C0CD2

Social Work/Helping Profession/Mental Health

Geriatric Social Worker

This is worth reading from the perspective of a geriatric social worker-one who works with seniors…..

http://www.socialworker.com/home/Feature_Articles/General/I_Am_a_Geriatric_Social_Worker%3A_A_Walking,_Talking,_Living_Resource_For_All_Your_%22What_Ifs%22/

Aging/Gerontology, News

Seniors cared for in hospitals as no where else to go….

Seniors/older adults go to the hospital due to illness, disease, crisis and then what?

“national statistics show there were 4, 200 so-called Bed Blockers across the country, half of them waiting to get into Long Term Care.”

There needs to be an affordable solution. Home with care or LTC placement? More of both need to be created, but the biggest obstacles are money, staff and quality care.

http://www.cbc.ca/thecurrent/episode/2013/01/10/canadas-hospitals-strained-caring-for-elderly-patients-with-no-where-to-go/

Healthcare

Creative Solution to the Senior Population in Milan, Italy

Milan, Italy is implementing an ‘adopt’ a senior idea to provide additional support to the over 65 demographic.
– “Italy has the highest percentage of elderly people in Europe and by 2050 it is estimated that one person in two will be aged over 60 and one in six over 80.”

Read this article and see the creative solutions that other countries are coming up with.

http://www.italymag.co.uk/italy/milano/adopting-elderly-milan

Healthcare, News

The Council on Healthy Aging in Canada to be Created

Canada is facing demographic challenges driven largely by the transition of baby-boomers into their retirement years and the steady lengthening of life expectancy. By the year 2015, baby-boomers will be 50-65 years old—by 2035 the youngest boomers will largely have retired.  By then, almost a quarter of the Canadian population will be seniors in need of a wide range of services and supports to help them enjoy a high quality of life and, in some cases, to continue to work productively.

“The CHA is a new Executive Network dedicated to exploring the health-related issues and opportunities arising from this demographic change.”

http://www.conferenceboard.ca/networks/CHA/default.aspx

Aging/Gerontology, Healthcare, News

Housing for Older Adults with Physical Limitations

by Victoria Brewster, MSW

I came across this article on housing for seniors/older adults with high needs in London, Ontario. Everything about the housing unit is for an individual who is in a wheelchair and has physical disabilities. Wide doorways, low light switches, a shower built for a wheelchair to roll right in, doors that slide open so one in a wheelchair can tuck under the sink to wash the dishes. Bathroom counters designed for a wheelchair to fit under it.

Those of us that are mobile while walking on two legs take for granted the fact that we can look out the window. Imagine being in a wheelchair and not being able to do that. The housing includes lower windows, angled doors to allow ease of the wheelchair going from room to room.

The housing is also near shopping and other amenities and bus routes. The curb is lower to allow one to get in and out of a car easier and into a wheelchair or for those that have electric scooters to go up on the curb. Most importantly it is in a regular neighborhood and the house is designed as such that from the outside it looks like any home a nuclear family would live in.

If this concept can exist for older adults with special needs or physical limitations, why not for other segments of the population? Imagine being a mom pushing a stroller, carrying groceries and having to go up stairs to enter an apartment building or house? A ramp would be very helpful.

A quote from the article, “We have to look at different ways of how we manage our health care. We need to focus on home and community care to figure out how we can develop services that are more flexible and can change quickly as people’s needs change quickly. This house has a lot of opportunities for how we can support people in the future.”

http://www.lfpress.com/2012/11/28/a-new-london-home-for-people-with-high-needs-could-be-the-template-for-housing-an-aging-population

* First posted on: http://www.socialjusticesolutions.org