I live in Maryland, and many of our doctors have retired, or just left, because of paperwork. They are being replaced by Physician's Assistants or Nurse Practitioners. I have a real problem with my husband since he was very attached to his Primary Care Physician, considered her a friend, and trusted her implicitly. When she retired very abruptly (I thought she was 10 years younger), we were assigned a PA. I took him to her several times as his foot was swelling and a sore was developing on his heel. She sent him for xrays and tests and finally the office said I could not get another emergency appt with the PA because he had already had two emergency appts. So I took him to the ER. They hospitalized him for a severe infection that went down to the bone. They could not find a hospital bed for him; had to send him far out of our region. I liked the dr. there, and I told him about all the concerns I had about him, mostly cognitive and radical behavior changes, which I thought might be due to a UTI. That dr. said he would give my husband a thorough examination, but when I went the next day, the doctor said my husband was being released. He has to see four specialists now, and all of the appts are weeks and months away. Thank God for the home nurse, who changes his dressings and is the only one who gives me straight answers. Today he finishes up his antibiotic pills that he received at the hospital but it is still 10 days before he can see the PA (who I really blame for his having to go to emergency room in the first place), and I have had no help with his behavior changes and he is hallucinating a lot. I am very frightened to be left alone with him. I feel that the whole medical profession has been ruined. This is basically a vent. Thanks for listening.
It is only going to get worse.
We actually already have socialized medicine, we just pay personally for the crappy system it has become.
Just before my LO was diagnosed with dementia, her very competent and attentive physician, who was a nephrologist by specialty but practiced very actively within the geriatric population, had also resigned, but just by luck, LO had almost immediately become attached to a geriatric practice of whom her original physician wholeheartedly approved.
then less than a year later, when she entered assisted living, I requested the doctor on staff there to be her doctor of record, and again, a wonderful match, and again, just sheer luck.
Are you considering another search for a geriatric specialist for your husband? In my state, not too far from yours, it seems to work best when someone has an umbrella oversight of the patient’s care.
My LO also has a rather complicated but so far VERY EFFECTIVE insurance plan, and it seems to support most (perhaps all) of the recommendations that are made for her needs.
If you have confidence in your “home nurse”, would it be worth asking her if she knew of any comprehensive geriatric practices near enough to you where your husband might have a chance to be seen sooner?
Your situation reminds me of some similar episodes while I was taking care of my mother.
My mother didn’t like doctors, and until she had a stroke at 85, simply never went to them. NEVER.
When she needed complex specialized help, there wasn’t any one for us to take her to.
Feel comfortable ranting. There’s ALWAYS somebody here who will listen.
You can refuse to sign for discharge, citing the fact that he is a danger to himself and others if he is still actively hallucinating.
Me, I'd call 911 again and have him re-admitted.
I find the PA's and nurse practitioners poorly trained and with limited knowledge. They do not have what it takes to make an informed diagnosis. They are no substitutes for doctors. They make guesses, but simply do not have the education to make a real diagnosis in ER or broad intake situations. They have sketchy knowledge about the most usual presentations of the most common illnesses but absolutely no clue about unusual presentations or even slightly rare conditions. I am not faulting the individuals who do these jobs; they are expected to do the job of a doctor with 4 years of medical school and several years of internship and residency requirements but may only have a 2 year certificate with considerably less rigorous requirements. There simply is no comparison between a PA and a real doctor.
It is time to get rid of the medicine-for-profit model. It has failed us utterly. Perhaps it is also time to fully fund medical school for qualified candidates and increase the number of fully qualified doctors to a number equal to that required. In the last year I have seen the number of doctors and RNs in our local hospitals and clinics decrease as the for-profit institutions lay them off and bring in cheaper PAs and cna's to do the work more cheaply. Then they raise the price they charge us to keep up the profits while we are deprived decent care.
Maybe try to se a podiatrist but, please do not let this go. A foot injury can be deadly.
Some years ago, my uncle, living in a rural area of central Pennsylvania, suffered a stroke. He needed to have physical therapy, but because of the convoluted system, there was some sort of "window" during which it had to be scheduled, but because he never received any definitive information on this, the opportunity was missed, and he spent the rest of his life in a wheelchair, mostly paralyzed on one side.
A few days ago, I saw an article rating medical care in 11 western countries, and unfortunately for many of us here, the US was #11.
Another problem is hospitalization itself--especially for patients with dementia, they can become delirious and they never recover from that. On the other hand, if the infection became RESISTANT to the antibiotics OR caught a hospital-acquired infection on top of his existing one he probably will need to be hospitalized again. With COVID running rampant he is in a terrible situation.
Oral medications are not enough when it comes to sepsis or blood infection. Antibiotics has its own risks including c-diff diarrhea and can impact the heart conduction system.
Behavior changes and hallucinations are not normal--he probably needs to go back to the emergency room. They need to reculture his blood, wound, urine and do follow up x-rays. and do fresh labs to see his kidney and liver status as well. If he has kidney or liver issues that too can cause behavior changes. EVERYTHING needs to be looked at in my opinion only. Who knows what is going on...he may even be dehydrated. But if he has underlying enlarged heart you have to be careful with fluids. Yes it is a mess you have to deal with.
NO ONE should do a zoom doctors appointment. They cannot palpate a wound, check blood pressure, hear a lung fill up with air, nor smell the patient. all of which are needed for a diagnosis.
And while I've had to use PAs before, I found that they are basically useless and nowhere near "almost a doctor". The Nurses have been far more intelligent and listening to the symptoms actually helped with diagnosis and information of which doctor to see (outside the PAs hearing)
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