What is medical ethics and does age dictate what medical care you receive? Is it the Doctors’ place to choose the treatment? Who then is left to advocate for our elderly population. Is it safer, therefore to call the ER to assist with transport or attempt fait at home? The Social Security Administration, its fixed income and the raising cost of living is putting fear of care into our elderly’s hearts in America. Yes, it is true there is some misuse of the Emergency Room, however 99% of the elderly avoid the ER like the plague. The basic living costs of Medicare the the risks & fear of being sent home without care and left with another bill or worse being placed in a Long Term Care Facility against their will. It is not the elderly and is causing this problem. Maybe this new perspective can assist our Emergency Room Doctors with positve communincation and basic assessment skills. Medicare has a breakdown between ambulance transport and patient care needs. For more information on ambulance transport go to go.usa.gov.iDJ or www.medicare.gov. Most of our older generation have hearing deficits which affect communication on the phone and in person leading to refusal of care, misdiagnosis of confusion, and uncovered ambulance transfer billing adding to our goverrnment deficit. What happened to active listening.
Let me share a true story. I will need to give you some patient history first. Fred is a veteran of our Armed Forces, he is in his 70’s and lives alone. His closest family member lives approximately 800 miles away. No friends available to assist with medical or shopping needs. He and his brother talk every Sunday. Fred lost his wife in 2006 and appears that he hasn’t vacuumed since. However his home is mostly kept up. A 2006 calendar is still hanging in the kitchen with tarnished silverware in the sink. Fred goes out daily for meals. He sits at the dining-room table most of the time. However the garbage is always emptied and positve self care is done. No body odor and well shaved. He fears the hospitals in our area due to his belief of misdiagnosis of his wife. Fred is a smoker and uses oxygen nomally only at night on 2 L per nasal cannula. Fred’s diagnosises include: CHF, COPD, peripheral neuropathy and is heard of hearing. He has a history of a fall in which landed him in the bathtub for 8 days. His brother called the police after not hearing from him on Sunday. Fred is a strong believer in the Lifeline and wears it at all times, even in the shower. Check out these 2 sites for emergency phone line services: www.lifeline.gov or www.LifeFone.com.
Fred’s Telehealth monitor reported a poor oxygenation reading of 78%, therefore an extra visit from Home Health Skilled Nurse was warranted. Fred was sitting at the table with his oxygen on and the garbage overflowing onto the floor. Fred appeared short of breath, puffy eyes and had a distended abdomen. All signs of cardiac involvement. Sue, the RN started the nebulizer and continued assessment. Oxygen saturations was down to 83%. A normal oxygenation is 90% and above. Sue checked the oxygen concentrator and found the dial to be at the very highest dose. She turned the oxygen down to 3 L per NC to assist with normal oxygen administration as ordered by MD. Fred refused ambulance ride. Sue refused to leave Fred without further medical attention. Fred agreed to go if she would transport due to previous experience of being sent home without treatment. Sue called ahead to inform Emergency Department of transfer and patients condition. Sue left her phone number in case of any further questions. Leaving Fred in the hands of the Medical Hospital. Sue when on with the rest of her day. However within 45 minutes the ER called requesting that patient be pick-up, because there was nothing wrong. Bravely she asking, “What medical treatment did he receive?” The ER Doctor then got on the phone and reported that there was nothing wrong with him and that he needed picked up immediately. After assisting Fred home and still concerned with his condition. Thankfully, Sue received an incoming call from VA Doctor questioning patients whereabouts and need for immediate hospitalization due to recent labs from ER showing Acute Congestive Heart Failure. Fred was instructed by VA nurse to use Lifeline. Sue left home knowing Fred would be taken care of by VA Doctor. The next day however, Sue came to find out that the ambulance came to patients home turned up the oxygen and left. Sue than was let go the same day from employement with the Home Health Service due to ER Doctor complaint. Two days later Fred was in the hospital fighting for his life. Keen assessment skills, character, empathy and moral conduct of the Medical Profession!?
Please note names have been changed to protect the innocent.