Those left behind…still

Today was my house call day…or half day.  I wish it were a full day.  Or a whole day.  Or a few days of my week.  I love my home visits.  My patients are largely the forgotten ones.  The ones who spent hours under the sun as children, playing in cops and robbers in the dirt, their mommas calling when the lights came on, years raising kids (older, forgotten versions of themselves), and now they have shrunk down into brittle memories of their parents.  They can’t get to the office and most don’t have family to shuttle them into our office.  They have outlived their “people”.  So they have me.

The first house was to what could clearly be something right out of a Hollywood haunted house movie set.  Dilapidated two-story.  White paint worn off the wood decades earlier.  Second story windows boarded up.  Front porch screens torn.  Sometimes Cecil answers the door. Sometimes not.  I pick my way across the broken floorboards and stray-not-so-stray cats and carefully sit at his table so we can chat about what ails him.  He is forgetful and usually refers to me as “that nurse”.  I know he’s secretly happy to see me.  I’m pretty much all he has these days.

The next house is a brother/sister team who have more ailments than I have time to list.  And some of them painful.  Their house smells like something illegal.  I ignore it and take my migraine medication as soon as I get back in my car, leaving the window half-open so my other patients don’t finger me.  Narcotic medications are so tightly regulated, they can’t get them from their specialists.  This is what happens when too many prescriptions were written then narcotics were getting into the hands of the wrong people and then legislators had their usual knee-jerk reactions.  Patients who were good, honest people now suffer.  They can’t make it in to pick up a monthly prescription.  Nor can they drive every thirty days to their pharmacy.  Because they can’t drive anymore.  A neighbor checks on them once in a while and they get meals on wheels.  It would be an ethical violation for me to prescribe and pick up their narcotics.  Of course, not unless something happened.  But in this day and age, who wants to risk their whole life and license?  So as long as I don’t see it, I don’t say it.  No harm, no foul and they are not in writhing pain.

The third and fourth houses are much of the same.  These are the forgotten people.  The invisible ones.  The houses we all drive by, the ones which look almost vacant but not quite.  We wonder who lives there from time to time as we zoom by on our way to work, to run errands, to pick up our kids.  What I wonder is, what do those next door neighbors think?  What do they wonder?  Do they wonder enough to drop by?  To clip the bushes?  To cut the lawn on a regular basis?  Not ask, hoping for a polite turn down, but just get up on a Saturday and just do.  Who brings them food?  Who takes care of them when they outlive their family?  Close friends?

They don’t all go to nursing homes.  Or to live with families.  Or drop dead the moment they have ceased to be able to care for themselves.  No.  They are forgotten.  Forgotten too much, too often.

 

 

Can I just vent a little?

You see these kids? These kids get little to no medical. When they do, they don’t complain.  But, wow, this week was a whole lot of “What? What? What? WHAT? WHAAAAAT?” with my patients.  I love my patients.  Don’t get me wrong.  But, wow.  Some of the new ones under the Affordable Care Act think I am a concierge. I had a few come in this week with a “sore throat” and then added , “Oh and I have had a hip pain for six years I need you to look at and a spot on my back that’s been there a while and since I’m here, can I ask you about my neck?”  In order to keep our doors open, we are allotted a measly fifteen minutes with each patient.  Fifteen ticks of the clock to greet, ask questions, lay hands on our patient, and then formulate an agreeable plan, write the plan, scripts, and explain things.  Fif-teen minutes.  It’s barely enough time for a sinus infection.  Yet under the new insurance rules, we are expected to wear capes and rush our patients through like we’re on the high speed Accela.  I don’t like it one bit.

I spent 12-14 hours per day at work this week.  I don’t get overtime.  I don’t get comp time.  I don’t get a thank you from anyone.  What I do get is to walk into a fully booked schedule day after day and wonder how long it will be before I make a mistake because the train is moving awfully fast some days.  I want the best for my patients.

If you are patient at any practice, remember that if you make an appointment for an earache, please don’t say, “and by the way” or “could you also look at” because you know we will and that means the train will slow down for the next patient.  If all of  you do it, the train won’t hit the end of the tracks until hours after our dinners have chilled and our kids have gone to bed.  And these kids in the photo?  They still won’t get a single drop of care.  That’s the inequity of care in the world.  And it sucks.

 

 

Why we practitioners sometimes run late

So you, the patient, arrive on time, check in, and are placed in an exam room, patiently waiting to be seen.  For about ten minutes.  Then fifteen.  After twenty, you are pretty frustrated, right?  Yeah, I would be too.  By the time I come, seemingly strolling in, smiling, you are about to strangle me with my stethoscope.

Before you think I’m being careless with your time (and mine, because, after all, no matter how many patients the phone room shoehorns into my schedule, I can’t leave until every last one has been seen), let me tell you what likely occurred before you facebooked  your dismay to your 358 closest friends.

My day typically starts with an 0800 patient, followed by a new one scheduled every fifteen minutes. That’s right, fifteen short minutes to query your ailment, take a look and listen, review your allergies and medications, and decide with you what the best course of action would be.  If it were up to me, I’d have 25 minutes per patient but the poor payments by insurance companies dictate the only way we can keep our doors open would be to fit 20-25 patients in per day, which translates to shorter visits than practitioners would like.

This past Tuesday here’s how my day went: The first patient was a run-of-the-mill sore throat.  The second was a new patient.  New patients are typically half an hour visits, meant to be meet-and-greets and not much else.  They are not meant to be acute or chronic illness visits.  However, I walked in to a man about my age who burst into tears.  He profusely apologized but his son had died in his arms a few days prior from a heroin overdose.  This father had tried everything he could to help his twenty year old son yet heroin won out.  It was heartbreaking.  And even half an hour was not going to be enough to help this man.  If it were you, would you want me to look at my watch and hurry you along out the door?

The next patient made an appointment for an earache.  Simple enough.  Surely, I could get back on track.  But she kept adding, “and while I’m here, could you look at…” questions.  As did the next three patients.  I felt compelled to look at their various complaints as they were loyal patients and the complaints could have turned out to be serious.  You’d want me to take a few extra minutes to address yours, right?

And so it went.  And that is how us providers sometimes arrive in your room woefully behind.  It is not that we are not mindful of your time (or ours).  I’ll remind you that we cannot leave until every patient has been seen.  Every phone call has been returned.  Every pharmacy question has been responded to in a timely manner.  And every urgent lab has been addressed.  So long after every patient has gone home, we are still there, working hard for our patients because we love, love, and truly love what we do.  And we care.  That sense of caring and loyalty is WHY we sometimes run behind.  It is not a lack of awareness as to the time or schedule.  It is that sometimes one or two patients have an emergency so urgent that we cannot run on time.  What about the patient who fell last week in the waiting room because he had forgotten to take his blood pressure medication?  If it was your father or grandfather, would you want me to call 911 and send him on his way or would you want me to interrupt the train of patients to properly assess and comfort him before deciding whether a trip to the hospital was even necessary?

I love what I do.  I often tell my patients that I feel guilty calling it “work”.  I feel like I am going somewhere but it doesn’t feel like work.  However, if I am running late, as the patient, please understand it doesn’t happen all the time.  But when it does, it is likely because a patient deeply needed me to give them more time.  Or a few patients only made an appointment for one ailment but added multiple complaints once they got into the exam room.  If you have multiple unrelated complaints, please be honest when scheduling your appointment.  I’d much rather know up front so that I can have my staff adjust my schedule accordingly.

But above all, know that I truly and absolutely love my profession and want to give you, my patients every ounce of caring and excellent care possible.

 

 

Wellness all that fru fru stuff

As a nurse, I often get “those calls”…come on, if you know a nurse, you know you’ve done it at one time or another…had an ailment, weird rash, or nagging symptom of what could be a major malady ready to relegate you to the couch with a box of Kleenex.  Those calls are the ones in which I am asked to correctly diagnose, over the phone, without any kind of assessment, someone’s illness, rash, or injury.  I’m game.  I’ll play along.  I’m  not a doctor, but I play one on te phone.  So I get told about the entire illness, rash, or injury and am placed in the role of the tele-diagnosier.  I offer the usual disclaimer about only being a nurse and they should see their doctor then guess what I think is wrong and suggest ways to effectively deal with the illness, rash, or injury.  My “patient” on the other end of the line usually argues with me, skeptical that I might actually know what I am talking about.  It is not them, I think, who has seen more butts, wounds, and weiners in one shift than they’ve seen in a week.  However, as always, my telephonic patient exclaims that their friend, mother, brother, or mailman has suggested another remedy for the suspected malady and they think they will try the non-healthcare personnel’s ideas before mine.  And, as always, about a week later I get a call that the suggested remedy was a complete failure and the “patient” went to see their doctor (remember, I encouraged a medical visit a week ago)….and their doctor told them their illness, rash, or injury was exactly what I had alluded to just one week before.  They needlessly suffered for an extra week because what their mother’s best friend’s sister who does nails for a living was so much more likely than what I, the registered nurse, BSN, had stated.  In the end, the telephonic patient listened to the offerings of the MD because in a white coat, he is so much more believable than me…

It doesn’t make me mad or frustrated but rather makes me laugh every time I hang up the phone because I can easily appear psychic as I know the rest of the story before it happens.

So here’s your tip for the day:  if you have a nurse as a friend and decide not to see your doctor but call your favorite RN who then tells you to see your doctor because you need to be treated for whatever the ailment is…save yourself a week and call your doctor.

In the meantime, have an honest discussion with yourself about whatever health issue you may have.  Pick one small thing you can do to help your body be healthier…park a little further from the building, test your blood sugar, don’t put salt on your meal, or just….do something. Your family and friends want you to be around a while longer.  Be good to you because you are important.   Merry Christmas!

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