Spoiler alert: If you want to preserve the illusion that hospital care for the elderly is efficient, cost-effective and caring, read no future.
My father spent more than a week in the hospital after his collapse in January 2011. He received physical therapy to help him walk again. He received antibiotics. The nurses were caring and on the ball. But what the heck was wrong with him?
I never got any real answers.
By the time I arrived in Gainesville, my father had been on antibiotics for two days. I wanted to know what the infection was. After several days of pestering, one of the nurses confessed: They hadn’t taken a urine sample for testing before they started the antibiotics, so there was no way of knowing what kind of infection he had. They presumed he had a urinary tract infection. Since antibiotics are the necessary treatment, they had started him on them right away.
I was stunned. “Presumed”? That seemed a dodgy way to make a diagnosis. However, since then I’ve learned my father’s experience was actually pretty typical. Hospitals routinely misdiagnose and treat elderly people for UTIs. In fact, according to a 2009 paper by George Woodward in the Journal of the American Geriatric Society, research indicates that “UTI is incorrectly diagnosed in as many as 40% of hospitalized older people.” Older people frequently get UTIs, so someone being admitted to a hospital is often treated for one as a matter of course.
However, this weirdly nonscientific treatment plan wasn’t the only troubling thing about my father’s hospital stay. My father’s long-term geriatric doctor–who practiced in a building connected to the hospital–made little effort to figure out what was wrong with him or to communicate with me.
Every morning before 8 a.m., he of course visited my father’s room. He checked on his vitals, kept the antibiotics prescription up to date, and left. The visits took less than five minutes–usually, around three. When I called his office to make an appointment with him to discuss my father’s collapse, the receptionist told me he didn’t have time to see me. I’d have to catch him in my father’s room. When I was there the next day at 7:30 a.m., the doctor spent one minute with me, at most, and rushed on to the next patient on his rounds.
I understand, of course, that the doctor probably had multiple patients in the hospital, that he had to make his rounds before going to his private practice. But not to even schedule ten minutes to meet with a caregiver–one who told him that she had flown from overseas to be with her father? I wouldn’t call that humane.
He rarely returned my phone calls. Our single face-to-face conversation went something like this: Me: Doctor, what is wrong with my father? Him: Your father has an infection and is dehydrated. Me: But what kind of infection? Him: Probably a UTI. This is common in the elderly. Me: But he’s not making sense, he’s confused. Is something else wrong with him? Him: Excuse me, I have to go to another patient.
Cost for each 3- to 4-minute visit to my father’s room: $375.
When my father was diagnosed with Alzheimer’s, in rehab, two weeks later, I tried contacting this doctor to ask him why he hadn’t been the one to suspect it. The doctor and I had made an agreement four years earlier: He was supposed to test for dementia at regular intervals and to inform me if any of the results came back as suspicious.
When I tried to contact this doctor after the diagnosis and get his feedback, he was unavailable. I can’t even begin to express how angry and frustrated I was.
Have you had a similar experience with a geriatric doctor who failed to identify dementia in a long-term patient? What did you do? How did you feel?
For the previous post in this series, see Why Didn’t I See It Sooner? Real Life Adventure #4.