Sunday, March 6, 2011

MDs versus DVMs

Having spent the last 2.5 days watching my grandmother's ordeal in the hospital, I have come to really ... dislike? ... our health system. It is inefficient and disorganized, to say the least. This is not an indictment of public health care versus private or that sort of thing. I am grateful that we have such good medical care in this country, but really, I found this disturbing.

My grandmother had a carotid ultrasound to rule out severe atherosclerosis/carotid stenosis contributing to her condition. She then underwent an echocardiogram to determine if any emboli foci were located in her heart. She also underwent a CT scan, supposedly with contrast - I assume to determine if a mass was present in her brain. She could not have an MRI due to her pacemaker.

In her 2.5 days hospitalized, she saw the hospitalist twice. None of the doctors who "read" her ultrasound and echocardiogram discussed the results with her. No diagnosis was determined. She was discharged with the vague determination that it might have been a TIA (transient ischemic attack), but that it could also be a mass in her brain. There was also the intimation that her blood pressure was poorly controlled and that this might have caused the "incident." As a result, she was put on a new, additional diuretic, as well as Crestor. No real explanation, no discussion of life-style modification (diet, stress, etc). Not a single doctor saw her the length of her Friday stay, only nurses and medical assistants. No one came around to answer her questions.

Further, she came home with all of her medical test results - the results of the carotid ultrasound, the results of her echocardiogram, CT scan, and her blood work. The echocardiogram report had not a SINGLE measurement listed. It had all of the parameters that were supposedly measured, but where her results were supposed to be, only an /E/ showed up. My mother theorized that it meant everything was normal. However, on reading the results and conclusions, she did have some abnormalities that would have led to abnormal measurements. Yet, nothing was recorded there.

Even worse, the conclusions and findings stated that the echocardiogram was of limited and mediocre quality - making interpreting it difficult! Seriously? It wasn't even done well, yet her insurance paid for it.

Then, I read the CT scan report. My grandmother was given IV contrast for a contrast study. She explained it to me when I went to the ER. She was lucid, but having difficulty speaking. I confirmed with my grandfather that they had indeed administered a contrast agent prior to CT. Yet, when I read the CT report, it was titled: "CT scan without contrast." The conclusions also stated that no contrast was administered.

I was horrified at the ineptitude and callousness indicated by this combination of things. Tests were run, no results were explained, some of them were recorded incorrectly (and the CT possibly interpreted incorrectly), my grandmother has no idea what happened to her, and we have no idea of prognosis or what to expect.

If I, as a veterinarian, provided this kind of service to my clients, you'd better believe that I would hear about it. Clients are often belligerent if they wait ONE HOUR for test results, let alone 2 days, and no answers. I would feel I failed my clients if I treated them in such a fashion. Sure, there are plenty of times when I don't have the answers, but I tell clients that - and I tell them of the ways (and refer them) we can find out.

With my grandmother, we have many questions, but no answers. Two months ago, she had an episode where she lost the feeling in her foot. She was dragging it and unable to manipulate it. She was seen at a different hospital and underwent a slew of testing, all finding nothing wrong.

And yet, something is wrong. The loss of the ability to use her foot (now returned), and her current aphasia, indicate a medical problem that is still present and needs to be addressed! Shuffled between her PCP, the ER, and the intermediary ward, she is being passed from hand-to-hand, and no one is really looking out for her overall health. Doctors are so specialized these days that they can't seem to step out of their boxes and look at a patient's total health. I am beyond frustrated and feel like my hands are tied. What can I do to advocate for my grandmother from 650+ miles away??

Meanwhile, I am extremely worried about her. Her speech is improving daily, and she was able to do a crossword puzzle, Sudoku, and a complicated word puzzle with me tonight, but as I watched her write, it was obvious her brain was still mixing up letters. She knew the word exonerate and stated it clearly, but then she struggled to write it. There is something occurring, and I am powerless to help!


ERDOC said...

I'm infuriated for you. The only thing I can say, is BE the squeaky wheel. don't let them sweep your concerns under the rug. Complain until someone responds, ask questions until you feel satisfied. seek a second opinion.

Of course, you know all this. I know that you're frustrated - and I'm frustrated for you, too. Hang in there. Your grandma is lucky to have such a brilliant grandchild!

HP said...

Infuriating! I am so sorry to hear about your frustrations with our human medical profession - I recently experienced similar things myself. I shattered my middle finger and the critical care place we went to didn't have x-ray... but instead of telling us right away, we waiting an hour until we saw a doctor who told us he had a golf game to get to, so he'd refer me to a colleage. GOLF GAME - I wish I were kidding. When x-rays were finally taken, they refused to show me, just saying my finger was "broken" and that I needed a hand specialist... a week later. They didn't tell me my proximal phalanx was in 4+ pieces! They splinted my entire arm to hold me over until I saw the specialist - with a splint intended for the opposite arm so I had some major bruising going on from the awkward position of the splint until I realized a couple days later what they had done. Not to mention that I suspected my index finger was broken too, but when I asked them to x-ray it, they flat out refused and collimated down to just my middle finger. A week later I was x-rayed again at the specialist and lo and behold - my index finger was fractured as well.

Its just plain insanity what goes on in those hospitals... I cannot even fathom what clients would do if we did and said a fraction of what human doctors get away with!

Outrider said...

This isn't unusual at all, in human medicine. I could tell story after story. The irony is: physicians think they're doing an excellent job, and believe they're underpaid, besides.

This is why one of my friends who is a veterinarian is my health care proxy, not a family member. This is going to be tough for you because you don't live nearby, but you're the educated voice in your family. Speak up.

Anonymous said...

That is SO frustrating. Honestly, I think some doctors feel entitled to act in such a way, and the disorganization of the health care system is unbelievable. I would definitely inform anybody I was speaking with that I was a doctor as well, and like the others mentioned, be the squeaky wheel! That's the only thing you can do in this situation to get anywhere. I'm thinking good thoughts for you and your family!

Holly said...

I am so sorry for you! And your grandmother. How terribly frustrating....I wish I could help but this is SO not my field.