Last night I received a hospital consult on a 92 year-old man with severe, end-stage Alzheimer's disease. He'd been found unresponsive (at least, more unresponsive then usual) in his wheelchair at a nursing home (where he's lived since 2009), and was subsequently found to have a huge stroke.
Of course, the computer chart program inserts this paragraph IN EVERY DOCTOR'S NOTE on him (including my neurology consult), regardless of whether we actually want it in there. Because, it's what the hospital admin people say is important for good patient care. And who knows more about good medical care than an administrator with a business degree?
the joint commission, that's who.
ReplyDeleteThe question of safety concerns with your home: is that for the patient or the doctor? the other questions ask if the patient has issues, but not this question?
ReplyDeleteBut, But But Obamacare is making it all betterer for everyone.
ReplyDeleteWhy does anyone insist on transporting a 92 year old guy with end stage Alzheimers who is unresponsive to a hospital?
ReplyDeleteLife Expectancy plus 1 day, you are now strictly on your own.
The only people who know less about good medical care would be in Congress, the Senate, and insurance companies. Well, maybe babies and the dead know less.
ReplyDeleteI especially like the grammatical problem in the first paragraph, where after asking about the patient they suddenly ask "Do you have any safety concerns with your home environment?"
ReplyDeleteI called my mother-in-law's insurance to discuss something after she had a stroke last summer, and they asked me the Ebola questions about both me and her. I laughed out loud at the screener. And mocked the hospital system for requiring it, reminding them that at that point (I think it was October) asking flu questions would make a LOT more sense.
LOL
ReplyDeleteWhat happens when a lawyer gets hold of this and uses it to show the records are inaccurate?
ReplyDeleteWelcome to socialized medicine
ReplyDeletehttp://www.hedweb.com/bgcharlton/cargocult.html
While waiting for admission to hospital I was in the ED for 14 hours. A prisoner was handcuffed to the gurney outside my room with 2 or three guards flitting around. His intake questions included: "Where do you live?" and "Do you feel safe at home?" I would have given anything to here his answer to the second question!
ReplyDeleteNothing about menstrual cramps?
ReplyDeleteAmen, Packer. Amen
ReplyDeleteBS,BS,BS.
15 years ago, my brother went into the hospital less than a week before he died of metastatic cancer (no palliative care option - he had been at home). The cancer had rendered him non-responsive by then.
ReplyDeleteAmong the intake questions - does he wear glasses, what are his favourite activities -- I (nicely) told the nurse that I didn't think it really mattered at that stage.
I was asked about the travel to West Africa at my last doctor visit, I told her I had not been to West Africa but that I was in Westville, Indiana. I was quarantined for 21 days.
ReplyDeleteI especially enjoy the canned/emr discharge summaries that are presented as walls of text. Or how about the ER notes detailing a FULL ROS and complete head to anus exam for a twisted ankle. I always ask my patients just how thorough the ER visit was, invariably it's " doc I don't think he even touched me"
ReplyDeleteAnd of course the computerized systems don't allow you to leave a question blank, or choose an answer such as 'not applicable', now do they?
ReplyDeleteSoftware programs for outpatient settings are not any better - teaching on sexual health by the urologist, even for the demented patient - the other nursing home residents are not going to be happy about this.
Works for the doc - upcoding of the services leads to better reimbursement.
I just use those questions as ice breakers as in "while you've been dealing with this devastating cancer, have you had time to run off to West Africa and get exposed to ebola?" -usually gets a small chuckle and then we move on to the important stuff. Our hospital's discharge papers encourage you to: 1)use car seats for your kids; 2) don't smoke and 3) don't kill yourself.
ReplyDelete-whitecap nurse
The EMR in my county is less a health program than a billing program written by lawyers. They introduced Anasazi saying it meant great futures. The real translation from Navajo is enemy of my ancestors. The perfect name for an EMR.
ReplyDeleteThis is why I want out of hospital nursing after 30 years. No one wants nurses who can think, or take meaningful steps to help improve patients conditions. They just want to make sure all the boxes are checked.
ReplyDeleteI just want to enter the patient's height and weight into the EMR database but it won't let me out without finding how many cigarettes the patient smokes per day, or if there is a possibility that the 91 year old woman is pregnant or expressed an intent to kill someone lately. Well, I suppose with the new treatment described on NPR involving mitochondrial culturing she could be pregnant, and I certainly could sympathize if she did want to kill someone if she is pregnant at 92 years. But, the EMR is so helpful. Imagine having to document that information in your own handwriting in the chart.
ReplyDeleteI just went to the doc for a skin rash and was asked if I had recently traveled to Tanzania!
ReplyDeleteThis canned text about Ebola and home safety fits right in with, "Your call is important to us..." doesn't it?
ReplyDeleteHow is this the fault of Obamacare or so-called socialized medicine? The "travel screening" may be a hastily developed response to the crappy situation that developed in Texas which left a man dead & 2 nurses with Ebola, in which case it is probably "defensive medicine" practiced in response to our over-litigious society.
ReplyDeleteIbee, at my employer these are called "dot phrases" and are easily deleted ... is that not an option with your EMR?
Why were they consulting neurology for an end-stage everything patient with a huge stroke? sounds like a palliative admit to me...
ReplyDeleteSo, I'm reading this way late, but I assume this is why the paperwork from my son's 9 month well child check states he has never smoked and his native language is English?
ReplyDelete