Sunday, June 5, 2011

"The Doctor Will See You Now" (and why everyone needs a patient advocate)

Friday, I took my mother to an urgent care facility.  She was having severe pain in her right knee and it was making it almost impossible for her to walk. 

Two weeks ago, before the pain was this severe, she had finally been able to make an appointment for herself at one of the "doctor's" offices listed in her insurance directory.  It was actually the same office that had told her previously that she couldn't be seen by any of their doctors for 3 months.  But somehow they managed to get her in to see a DO on that day.  However, when she got there, she was only allowed to see a PA.  And they didn't listen to her complaints.  Or pay attention to what she needed.  They decided to do an EKG on her.  But the nurse (or medical assistant) didn't know how to attach it.  Apparently there is a left and right to the apparatus and she didn't know whether it was the patient's left and right or HER left and right.  It took a while and several consultations with other nurses (or medical assistants) before she figured it out.

After two hours at that office, she was told her heart was fine, but she needed to come back for a diabetes test in the morning. 

Nothing at ALL was done about her knee.

Now maybe SOME of this was standard first office visit health inventory for an older person---but that she left the office without anything being done about her knee shows that there is a HUGE gap in the communication process in the health care field.

So Friday, I went with her.  And we gave up on trying to make appointments at a doctor's office and went straight to the urgent care concept.   We hoped we would get a real doctor (an MD), and if not, maybe a competent someone else.  ;)

The first urgent care facility listed in her Humana Gold Plus directory was rather close by.  I thought, "how lucky," but when we arrived, we found it empty and with a "for rent" sign in the window.  There HAD been an facility there, but it was no longer.

We chose the next closest "urgent care" center.  It was a 15 minute drive away.  When we got close, we saw the sign from the highway, "Urgent Care" and a big arrow pointing the way into a large professional park.  All sorts of corporations had their offices there.  We had the address.  280 River-something Drive.  The first address numbers we saw were 5500 and 5100.  This was not a promising sign.  How were we going to get down to 280 any time soon?  Maybe we were on the wrong road in this development.  After turning on River Bend Lane and River Park Way and River-something circle, we finally backtracked to the first River-something road.  Pulling in to each and every corporate building, we finally saw a tiny sticker in the window of an office.  It said, "Riverwoods Urgent Care."  There were NO signs on the road or anywhere else near the building.

After 1 1/2 hours in the waiting room and another 1/2  hour in the patient room, we finally got in to see a PA.  He listened casually to my mother's complaints.  Then he listened to me, as I clarified and emphasized certain needs. (Like that she be able to WALK!  And that we really needed a referral because she had no reliable "primary care doctor.") At some point in the dual conversation, he caught on to what was REALLY needed.  It was like a miracle happened and he went into action.  He had his nurse/secretary/medical assistant call and try to arrange for an immediate appointment with an orthopedist.  He asked my mother questions and then told her the verbiage she needed to answer with in order for him to get her the best help.  Questions like, "have you fallen?"  She needed to say, "Well, almost."  Or, "Do you knees lock?"  She needed to answer "yes, I think so." In the end, his secretary DID get an appointment with an orthopedist for Monday morning.  And he prescribed a strong anti-inflammatory that targets joint pain to tide her over the weekend.  He treated my mother with respect and kindness and got her the help she needed.  He made jokes with her and put her mind more at ease.  He turned out to be a good PA.

But I don't think she would have received the help she needed if I hadn't been there.  I don't think he would have listened fully to her.  Or understood what she really needed.

This is a common problem for older patients.  They are not listened to.  They are treated like they are children that don't know any better.  But I also think it is a common occurrence across the board for every patient.

My married daughter swears that ALL people need to have a patient advocate with them.  When she went through her very difficult pregnancy, she found that if she had her husband with her, she would get the medication and care that she needed.  If he wasn't there, they didn't even listen to her.

And I am starting to believe this is true.  A patient is sick or in pain.  They are nervous and unhappy.  They are, many times, half naked, sitting on a table covered with crinkly paper.  They are tired from waiting in the waiting room, and half-crazed from being forgotten in a patient room for an hour.  They have told their medical problems once on the phone when they made the appointment, then twice to the nurse when she weighed them and took their blood pressure (more stress).  When they finally get to see a doctor and are asked for the third time what is wrong, they may not be able to be coherent any more.  It may all blurt out crazy and confused and emotional.  They may forget things.  They may tell it wrong. 

The doctor then makes a first impression of "whackadoodle patient" and it is all downhill from there. 

But if there is a patient advocate, everything is different.  The doctor can't be rude.  The patient is a loved one of this perfectly reasonable, fully dressed, and not in miserable pain person.  He MUST listen attentively.  The patient feels safer and so is less stressed and better able to communicate.  If something is explained wrong or misunderstood, the advocate can correct and restate it.  If the desired outcome isn't happening, the advocate can push for it.

And if the doctor's office is closed down or not actually findable in a big professional park--the advocate can stay motivated and keep driving until it is found.

For ALL these reasons, I believe everyone needs an advocate when they seek medical care.  I'll be taking one next time I go.  ;)

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