Tuesday, February 23, 2010

Why It Was So Easy to Sell The Myth of "Death Panels"

Until recently I simply could not understand why so many rational, intelligent and, in many instances, well educated Americans could believe that the proposed health care reform legislation would include "death panels" for senior citizens. However after the events of the past week, now I understand.

A recent visit to an emergency room with my mother and her subsequent hospital stay have absolutely convinced me that many of our young health professionals and, in general, the US hospital system view the health care needs of senior citizens with disdain if not outright contempt.

Democrats/Liberals/Progressives (Republicans*), this is what you need to understand. Many senior citizens are simply afraid of our health care system, and rightfully so.

When seeking medical care, all too often, the legitimate complaints of the elderly are dismissed as senile rantings. Even when a family member or caregiver is acting as an advocate for an elderly person, their voice is often ignored. And let's face it, most caregivers are women. In fact, since women generally outlive men, most senior citizens are probably women. Is a picture emerging? 

As I've shared bits of my family's story over the past week, I've heard numerous equally horrific examples of disrespect, callous treatment and in some cases probable medical malpractice. It is enough to make you very afraid to grow old.  Briefly here is what we experienced.

My mother was taken via ambulance to the emergency room of a local hospital at 5 pm on Tuesday, February 16, 2010.  I advised both the paramedics and the attending in the ER that my mother was diagnosed with NPH (normal pressure hydrocephalus) in 2005 (the actually diagnosis was in 2004 but the date was changed to protect my mother's privacy when this was originally posted*)  but recently she had been experiencing a drastic decline in mobility. She had also been complaining of pain in her right ankle, knee and wrist which might be the result of a fracture sustained during a recent fall.  In addition, and not in any way related to a diagnosis of NPH, a large unknown mass had appeared on her abdomen.

At approximately 1 am, Wednesday February 16, 2010, we were still in the emergency room and I had to repeat the same detailed information again to the admitting resident.

  Finally, at 3:30 am, after 11 hours in the ER, my mother was taken to a room. Once again, I provided the nurse with a full description of my Mom's condition.  Later on Wednesday my mother was seen by a neurologist. In fact, I was able to have a wonderful discussion with him when I visited my mother later that afternoon. So far all was going well.

I was very troubled that my mother had had very, very little sleep in over 36 hours but I believed that she was receiving the care that she needed. 

I won't bore you with all of the details so I'll just skip to 11 am Thursday, February 18.  While attempting to determine just who in the hospital was coordinating my mother's care, I was advised that the attending intern/resident in the ER had failed to note anything on her chart about the abdominal mass or my concerns that my mother may have sustained stress fractures during her last fall.  In fact, I have good reason to believe that it was not until I brought the non-NPH issues to the attention of the admitting physician on Thursday that X-Rays of her limbs and a MRI of the abdomen had never been ordered. Needless to say, I was not a happy camper. However, at least now everyone was on the same page and all of my mother's health concerns would be properly addressed. Or so I thought.

Since the hospital was well aware that my mother suffers from NPH, a disease which affects memory and mobility function, I thought certain that they would contact me on Friday morning with her tests results. Unfortunately, not only did the hospital fail to contact me with my mother's test results, a doctor making his rounds on Friday morning told my mother (not I) that she was being released that day. My mother called me at home at 2pm on Friday and informed me that she was being released. After confirming this with the nurses' station, I contacted the hospital's social services office and, in a very forceful manner, asked that they make arrangements to have an ambulance taken out of their establishment asap. Yes, I ranted and now, of course, those rantings are being chalked up to caregiver burnout.

 My mother's discharge papers simply read:
Discharge Diagnosis: Normal Pressure Hydrocephalus
Follow up with your office in one week
Activity: as tolerated:
Diet: regular
Discharge to: Home

There is no mention of any other condition.

Friends, this caregiver may have been tired before last week but if I'm burned out now it's because the health care system poured the gasoline and lit the match. Sadly, I am learning this this experience is not at all unusual.

Now this Northeastern (not the university, this is a geographical reference*) , college educated, middle aged, liberal understands why it was so easy for the GOP to sell the myth of "death panels" during last summer's health care reform debate. And I understand why town hall meetings turned into screaming matches.

If the US health care system already treats insured senior citizens so badly, it isn't a great stretch to believe that someone, somewhere, in the name of saving a dollar, wants to see them dead. It's not true of course, but .....

*Updated: August 2, 2015


  1. There are a couple of things here. None of these are excuses but explanations. And none of this has anything to do with your mother's age because my friend (and fellow physician) recounted a similar experience as caregiver for her younger sister post-surgery.

    First, let me clear up the misunderstanding that a resident is an attending. An attending is the head of the team and the residents work under him/her. So there is no attending resident, since that is a contradiction in terms.

    Next, remember all that hoo-ha over the past decade about residents working too hard and making errors because of fatigue? Well it changed into a more ridiculous scheme that values getting residents out after x hours worked at the expense of continuity of care for the patient. As such you now have cross-covering residents who are basically covering a ton more patients, putting out a million fires, but don't know much about the patients that aren't there own (and really don't have the time to sit and read each chart in detail as they should) being responsible for management of patients. They present to the attendings and the attending makes the plan. And as you have seen, the plan is only as good as the patient's admitting problem list. If items are left off the list or made into lower priority on the list (i.e. not directly related to the reason for admission or could be dealt with as an outpatient), they will not be addressed. Period.

    The mode is one of crisis management and not holistic care. At least in my day we were tired, but we knew our patients and were able to manage the issues on their problem list before we signed out. But now laws get violated if someone stays too long post-call or tries to do one last thing for the patient. So we traded off tired residents for horribly busy, disconnected, triage-level care instead. Not much progress, as far as I am concerned.

    So this isn't about seniors or death panels or any of that. It's about the degeneration of medical care in this day and age. It's one of the reasons I had to leave. I've never been a treat and street type of doc.

  2. So sorry to hear about your mom...The sad thing is this is not an isolated case...This is Healthcare in America.

    I agree with Teendoc...

    It's about the degeneration of medical care in this day and age.

    The scary thing to me is...This problem is going to get much worse before it gets better (if it ever gets better at all).

    Even with insurance I can not believe the amount of money my mother is paying for healthcare (and she's somewhat healthy at this point). My mother has actually made the comment to me that she hopes she doesn't live much longer...because she thinks she is going to become a financial burden on me. Obviously, I would rather have her alive and a financial burden than the alternative. But the idea that this thought would even come into her mind is a sad commentary on what our healthcare system has come to.

    I can't imagine how difficult it must be for you being your mother's caregiver (as sick as she is)...I'm sorry that the health professionals that should be working with you seem to be working against you...I'll be keeping you and your mother in my thoughts and prayers.


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