A 91-year-old woman calls her doctor complaining that she feels dizzy. No, that's not the beginning of a joke. It's what actually happened to my mother last week when she woke up feeling "a little sick." And here's the punch line. She ends up at the ER and in the hospital overnight. But the joke's on all of us because our tax dollars fund this approach to geriatric care.
Mom did all of the right things. She had the nurse at her senior living complex check her blood pressure and pulse. The nurse thought her numbers were low and told her to call her doctor for advice. So she did. And then she waited and waited and waited.
When no one from her doctor's office returned her call, mom called me to see if I could get through. The receptionist told me the "doctor" already had the message to call mom from that morning. I asked if he could call me and was basically told to get in line.
More hours pass. My brother stops by to check on mom and thinks someone should see her. It's now late afternoon. He decides to take her to her doctor's office, expecting that someone there would be able to take a quick look at her. I call to let them know she's on the way. I immediately get the "doctor" on the phone.
He tells me he's "not impressed" by her low blood pressure and pulse numbers because she's old. What matters is how she feels. I tell him she feels poorly. That's what she said when she called that morning and what I said when I called early afternoon. He instructs me to tell by brother to go to the ER. No one has time to see her at his office. If she's truly sick (we don't know this yet), she belongs in the ER.
We know what "go to the ER" means. A long wait. Exposure to illness from others. Lots of tests ordered by doctors who don't know mom's history. And a possible hospitalization for observation and even more tests, which is extremely disorienting for a woman her age. I live out of town, so my guilt kicks in. My brothers will be stuck taking shifts in the ER, because I know it will be hours before doctors see her, and even more hours until they decide to admit her or send her home.
All of my predictions about going to the ER come true. By the time she gets there, mom says she's feeling better, but I guess folks who are 91 don't get much of a say in their health care. So they do tons of tests and decide to admit her at 11 p.m. My poor brothers.
- MRI of the brain
- CT scan of the head and brain
- Carotid artery test
- Chest x-ray
- Complete blood chemistry panel (well, almost complete)
- APTT clotting time test
- Protime INR clotting time test
- EC Troponin test to check for heart attack
- CK MB test to check for heart attack
- ECG to check for heart damage
- Basic metabolic panel
- AST test for liver damage
Mom was scheduled for one final test the afternoon of her hospitalization, an echocardiogram to test her heart function, when the "doctor" stopped by to see her. He told her the test results were perfect (they are not, but more on that later). He canceled the echocardiogram because it was unnecessary and sent her home, telling her to, "Get out of here. Hospitals make you sick." Really? Then why did you send her to the ER instead of seeing her in your office?
The only thing the tests revealed were a slightly elevated white blood cell count, which means she probably had a mild infection or virus, and an incidental finding of narrowing of her carotid arteries. There was no mention of pursuing the latter, so we are left to assume that's just part of being 91-years-old.
To my knowledge and that of my doctor husband, who reviewed mom's hospital records, in all of the testing the hospital did they neglected to do two simple tests that might have revealed a cause for her symptoms. Since Mom is on thyroid replacement therapy, they might have wanted to check her thyroid level. They also did not look for a urinary tract infection, very common in women her age. No one ordered these tests because Mom was in the care of a hospitalist who did not know her history.
I can't pretend I have an answer to how to fix the mess of health care for the elderly. But it seems like there is nothing between neglect and overkill. When my mother-in-law was in a nursing home at the end of her life, she would frequently become dehydrated. These episodes led to many trips to the ER for fluids. Finally, we asked why they couldn't give her fluids at the nursing home. The answer: they needed a doctor's orders. Once we got this in place, she no longer had to suffer the pain and disruption of taking an ambulance to the ER and staying there for hours.
Sometimes, the solution to a huge problem is actually something simple. If there were a way for the elderly to be evaluated, and even given basic treatment by a doctor, they would not end up in our emergency rooms and being hospitalized. How to make this happen is the big question.
Back to that 91-year-old woman, my mom. I think the way her latest health problem was handled was very disruptive and upsetting to her and unnecessarily costly for all of us whose taxes fund all of these tests and procedures. Most of all, I think she deserves more respect than our current health care practices gave her.