Primary Care S.W.A.T. Team

It’s always awkward when a patient of mine who is hospitalized somewhere else calls me to complain about their care there. I’m obligated, of course, to check into the situation. But, I don’t have power or jurisdiction “somewhere else”.

So recently, when a patient’s family called my office in a panic about perceived neglect at an area nursing home, I immediately thought, “Uh-oh… this is not going to be fun.”

You catch more flies with honey than with vinegar, so when I called the home, I tried to sound as benign and conciliatory as possible. The nurses responded to my polite inquiry with genuine surprise and general kerfuffle, but no overt hostility.

Only a few sentences were exchanged. Then, a nurse passed the phone to the doctor in charge.

“Who is this? What do you want to know?” he asked, obviously ruffled.

Oof. I took a deep breath, and using my most apologetic voice, I introduced myself as the PCP, and said that I was making a continuity of care call on my patient so-and-so, at the request of their family.

The doctor then shouted into the phone,

“If you want to know about YOUR patient, have her make an appointment at your office, and ask her yourself!”

Click.

I sat, stunned, listening to the dial tone.

What???

In my head, I reviewed everything I’d said. It hadn’t been much, and I’d been super-nice.

I decided to call back and try again. A nurse semi-apologized, explaining lamely, “Oh, the doctor is just so busy today. He doesn’t have alot time for these types of calls.” She didn’t seem to know much about my patient, either.

So I called back, and this time asked to be connected directly to the patient’s room. My patient is a decent historian, and her concerning story and worrisome symptoms got my full attention.

The patient and I made a plan: We would take the doctor up on his suggestion.

We would have the patient come to my office for evaluation. I predicted, based on her serious symptoms, that she would require admission to my hospital, and from there, we would get her into a different nursing home.

I asked my secretary to make the appointment with the home, and ask them to arrange transportation for the patient (who requires max travel assistance).

An hour later, my nurse called me. The home was refusing to allow the patient to leave to see me. My poor secretary had been on the phone with them for thirty minutes, in a fruitless back-and-forth.

What???

The home was arguing that because I wasn’t currently involved with her care, I had no right to see her in my office.

What???

My nurse and I brainstormed, and finally, she called the home herself, and managed to convince them that they had to arrange transportation, or face legal action. Which, wasn’t far from the truth.

As the appointment time neared, I wondered if my patient would actually get to my office. I was envisioning needing to place calls to law enforcement, elder services, et cetera.

But the patient did get to my office, and stated: “I am NEVER going back to that home!”

The clinical situation was indeed terrible. The patient was truly sick, had clearly been neglected, and was immediately admitted to our hospital.

The whole scenario was like a rescue operation. SO chilling: If the family hadn’t advocated for the patient, and if my staff and I hadn’t been able to figure out how to get her out, or hadn’t been willing to try, she would be there still, suffering needlessly, rotting in bed.

Sadly, I know full well that there are vulnerable people who are suffering from neglect at homes or in facilities. Many don’t have advocates, or aren’t adequately connected to outside resources who can help. This case worked out, but I can’t help thinking about all the cases that don’t.