When all of your patients are doing okay, there isn't much to write about. As I see more and more of my outpatients, more and more often, I've been noticing there's a big range of home health aide competence, from the ones who barely know their person's name to the ones who take notes, actually pay attention, and act in a warm, caring way toward the patient. I think it's a pretty painful job, being a home health aide, especially to a demented person who doesn't have a non-demented spouse involved as well. It's a lonely job, certainly. And it's very easy to do it poorly, and hard to do it well. If you are an aide, and you're bringing your person to the doctor's office, you should probably clean them a little bit first, brush their teeth, put fresh clothes on them -- or you seem like a bad aide. If you ask questions, especially about medication dosing, you seem like a good aide. If you wait in the waiting room, and act like the doctor's appointment is your time to make a call on your phone, you seem like a very bad aide. If you bring a medication list, you seem like a very good aide.
Actually, it doesn't just apply to aides. If you bring a medication list -- an accurate medication list -- to the doctor visit, you win. The number of people who don't think that knowing what medicine you're taking is a good idea when you visit a doctor for the first time is really staggering. If I could pass one health care related edict, I think it would be that people should be mandated to bring medication lists everywhere they go. And if you've typed up a list of your medical conditions, surgeries, hospitalizations, names and phone numbers of the other doctors you see -- well, I want to give you a lollipop, because you are making your doctor's job a lot easier, and increasing the odds that you get decent medical care.
Also, if you're not the patient -- and you'd be surprised how often this happens -- if you're not the patient, I don't want to take your blood pressure, or weigh you, or answer your own medical questions. Home health aide, if you need someone to listen to your cough, make an appointment with a doctor for yourself. Spouse who is not my patient, please don't ask me to check your blood sugar. And no one is getting a medication refill except the patient I'm actually seeing. That means your sister, in another state, no -- I'm not calling in her refill, not even if you put her on speakerphone.
Monday, June 17, 2013
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Perhaps when calling in to make the appointment, the person who schedules can ask them to bring in a list of medications with them. Not everyone will remember, but many might remember...? just a thought.
ReplyDeleteThat's usually written on every medical document, in every office, and any time appointments are made. At least, here.
Delete"Please bring in your list of medications."
I've noticed a strong trend towards it over the last few years. I see more and more lists. And with iPhones, I get calendars, dates, everything.
So yeah, we do always asks for lists (at least here). It's more a matter of listening and bothering to care.
As a naive medical student I am constantly thrown by this whole prescription list/medical history thing. Not that people don't bring them ... but that it is even necessary. I mean, I totally understand that in the world we live in, it is necessary. But I get why patients think you should be able to tell THEM this. I get that isn't how it works, but everything else works this way. (As in my phone carrier tells me what calls I've made, when. My bank tells me what withdrawals, etc. But I have to tell MY doctor what medicines I take?)
ReplyDeleteYou are right, you are a naive medical student. A patient may have multiple doctors/specialists, and be on multiple medications, all prescribed by various physicians. Perhaps you are lucky and you have electronic medical records, and all the physicians are within the same system, the medication record may all be in one place. But often times, this is not the case. And if the patient is coming to see a specialist, who has never seen the patient before, there will be no history to look at. Yes, your phone carrier tells you what calls you've made, and you bank can tell you what withdrawals, but if you had two different bank accounts, could one bank tell you what is at the other bank?
DeletePlus, there's the whole issue of patient compliance. And, you can always just bring the pill bottles.
DeleteAbigail
But think about your analogy. If you called your mom on mother's day, shouldn't you be aware of that and not need the telephone company to tell you that you did? And your bank can tell you what withdrawals you've made....but since you made them, shouldn't you be aware of your account balance yourself? Similarly, I'd argue having open heart surgery should be memorable enough for a (non-demented) patient to mention when asked about a surgical history...
Delete(another non-anondoc anonymous)
I am NOT a naive medical student, but I understand the point very well. In our very much linked world, your IRA and your friendly NSA could very well tell you about ALL your bank accounts. And your home hard drive. Wait, I digress...
DeleteThe point is, in 2013, the medical systems SHOULD be linked. It's atrocious how difficult it is for me to get someone's records from the province next door. This is Canada, where we're still a lot closer linked than the states (medically speaking).
I can be in any part of the world, and access my bank account. And my cell phone account. But not my health history.
Now, I don't expect to change provinces and have the new doc magically know my history. But at least within the same BUILDING, where your patient sees eight doctors, I would expect them to talk to each other, and have access to each other's records. I KNOW that's not the case, but as a patient, that's what I would have expected. Until told otherwise. Then I'd be shocked and inquire as to whether the docs know what the hell they're paying their IT support for.
Our systems are not up to par. It's not the patients' fault for not knowing this.
The only exception is when they use medication doses not listed in the prescription or on the bottle. Then it's up to the patient to explain the dose to me.
And BTW, we do have a province wide electronic records system. It's beautiful. Still needs a lot of work, but I can access people's meds. Makes a world of difference.
I have RA and an as-yet not fully diagnosed/understood heart problem. I used to carry a list of meds to read off to my physicians because it is hard to keep track of everything I am on, and my meds list is constantly changing. More often than not, my doctors smirked as if it was the most amusing thing in the world to see a young patient writing a reminder list like she was an old lady. So I stopped doing it, and just go off memory as best as I can. I don't go to the doctor's office to get a dose of humiliation, I go there for help.
ReplyDeleteI feel like hugging my patients when I ask about medications and then see them fish some piece of paper out of their wallet/purse. It's a glorious moment.
ReplyDeleteIs it really the aides duty to actively seek out and then bring a medication list, though? Or inquire about the medications themselves? Its out of their scope of practice to give meds I assume.
ReplyDelete