snewman0409 Asked March 2016
How to get doctors, visiting nurses and facilities to work together to not have so many appointments? I fear I am going to lose my job!
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I am having to take so much time off of work because the Doctor makes me bring my Mother in to the office for something as simple as a blood test result...she also has a visiting nurse come in but some facilities choose not to "work" with them which requires separate appointments...I am at the least having to take her to an appointment 2 to 3 times a week....can you point me in the direction where I can get assistance in getting these place to work together?...
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My mom, living "independently" needed to be seen by PCP, Cardiology, Neurology, ophthalmology, etc. We consolidated. Mom went to Independent Living, where geriatrician managed all but the psych meds. On site geriatric psychiatrist managed those.
Pacemaker check. Internal meds. Cardiologist and when needed urologist and orthopedic surgeon. They were all in the same bldg. except primary but all associated with the same hospital and all had access to her medical records electronically. The cardiologist was my dads dr and we made an appointment with him to have my mothers heart checked out at 90. That led to the pacemaker. We utilized home health care that we chose based on reputation and had the dr write the order for. She saw all these drs once a year. All I did was start with the cardiologist appt and tell the others the day I needed. In the beginning the cardiologist ordered us the INR testing device so that my mother would have it when she visited with her granddaughter but the granddaughter wasn't comfortable with taking the readings so we just got a dr and home health in that location the couple of times she went for a long visit. Otherwise home health came once a week and took her vitals and filled her pill box. All her blood work including her INR was done at home and results were faxed to her drs. Adjustments were made as necessary to potassium, Lasix, Coumadin. My mother recorded her weight everyday. She had OT and PT ongoing over the years. When the CHF got out of bounds we would take her to the ER with the hospital all our drs were associated with. This resulted in admission where she would get the excess fluids removed and any other issues going on treated. This probably happened three times in eight years. When the CHF began to be harder to manage we added the Heart Transplant and CHF clinic associated with the hospital. This made it easier to get more advice on managing her episodes as they occurred. She also had a fractured spine ordeal where we traveled to the ER, did rehab and had a CHF episode. She preferred getting better medical care regardless of the long drive. The drs appreciated the long trip was hard and were willing to work with us. We did use the local ER a couple of times to get a Lasix shot when the fluid got too much but we were always holding our breath that we would have a hard time keeping the local ER from wanting to admit her in the local hospital which we viewed as a fate worse than death. Pretty much our rule was don't go to an ER where you wouldn't want to be in the attached hospital. After a couple of these local visits we started using the heart failure clinic and it was so worth it.
That is why I had really liked my parents primary doctor, as she was looking out for the grown child who was running up and down the highways with the parent(s) and sitting in waiting rooms, thus everything needed that doctor got done while we were there.
I won't really cut my nose off to spite my face, so I will try to go to physical therapy for me.
Who woulda, coulda thunk that we could go to the same place, together as recommended by P.T. Not happening.
Sendme, maybe if you were a unicorn you would fart rainbows too ;)
but alas you are only a woman and can only do so much!
He refused to reschedule, off he goes.
A fully autonmous adult with supervisory needs and needing a rep-payee.
Today, I am just giving up.
Just venting. Because I am sure if I was a better person, tried harder, he could have all his needs met. No advice needed here.
When we had PCPs, I told them I would ask the specialists to send them letters on visits. There's no need for a PCP to overlap a specialist such as a cardiologist. One PCP kept wanting to try a different cardiac med than that prescribed by the cardio who had been treating for over a decade. I told him no; that's a specialty area of medicine and the decisions stay with the cardiologist.
You can also ask at each appointment what would be required to happen that you need to return - i.e., it's a delicate way of asking what's REALLY necessary, not what they want.
I wouldn't refuse follow-up visits, but there are obviously too many of them taking place.
You might also try to select doctors that all have privileges at the same hospital. Check Mt. Pleasant and Midland, even though neither are quite close. In our area, hospitals and doctors are connected electronically so they can all access a patient's records through the hospital network. It greatly enhances communication.
It's understandable; there's a liability issue. The clinic has absolutely no way of verifying that the blood sample is from the patient - nor any way of veryifying the competency or accuracy of the nurse who drew it. So the clinic would be putting itself in the situation of prescribing Coumadin dosages to someone it had not seen or from whom it had not drawn blood. It's a potentially dangerous liability issue.
I also would query why your mother would need to go to the doctor's office when the pharmacists are more than capable of addressing the results, prescribing alternate levels, advising of potential interactions, etc.
Our cardiologist turned the entire practice of blood draw and management over to the Anti-Coagulation Clinic, and they were more than well qualified to handle all issues that arose.
I would raise this at her blood draw this week.
In the past visiting nurses have asked to perform blood draws and I explained to them it's not feasible, and that we would continue with the Anti-Coagulation Clinic. They understood; they were just trying to be helpful.
I once drew the line at no more than 2 medical visits per week; then dropped it to no more than one. Now we don't go for medical visits during harsh winters unless it's an emergency or a follow-up appoint on something really serious, such as vision status. Enough is enough.