Hospital "Care" (Update, Post #57)

[Reefgazer]

I can't figure out if the world has gone crazy or I have. What on earth is going on with medical care in this country? My dad is 91 and currently in the hospital with a typical set of "old people problems". He has slight dementia, doesn't want to eat and has lost weight, is on an IV for fluids, has a DNR in place (because we do recognize he may be at the end of his life and have accepted that), he just finished a two week course of antibiotics to get rid of a lung infection, had a blood transfusion because his blood count was low, and developed diarrhea, probably from the antobiotics. So...multiple problems that an old person can't cope with, but that a younger person would be able to deal with. Anyway, the diarrhea has caused him a bit of discomfort; every once in a while you'll see him wince. So the the first response to this diarrhea- induced wincing was Zyprexa, which of course is not recommended for elderly patients with dementia. He's not particularly agitated or psychotic. He just winces when his gut twists. Other than that, he mostly sleeps.

This seems to be the pattern at this hospital: Doctor recommends a mind altering drug for every. Single. Thing. It makes me want to ask where they went to medical school. Some backstory: Dad was in the hospital for dehydration, a lung infection (which cleared up), and he was on his way to rehab because his legs are weak. He left the hospital walking unsteadily, talking, reading the newspaper, joking,... so, functional, but weak. Within a few hours of arriving at rehab they hit him with Seroquel (because he was "combative". He is totally deaf, and they tried to talk to him and pulled him up, rather than write out what they wanted him to do). They returned him to the hospital completely nonfunctional - unable to walk or talk, with no control of his bowels or bladder, and unable speak coherently. He could not eat, and he went into spasms that required an ICU stay under sedation. They told me this was the result of delirium, however, these symptoms are also side effects of Seroquel. It took him a week for those medications to go out of his system, after we demanded that he be given no more mind altering drugs at all. And then he just stopped eating. OK, so we had to accept that this may be the end of the line for him and we spoke with the doctor about discontinuing medication (unless it was for some acute condition) and going to comfort care only. But since when does comfort care include mind altering medications to decrease agitation when the patient's problem is not agitation, but genuine pain of diarrhea (he doesn't appear to be a pain otherwise)? I'm stunned that these powerful antipsychotic drugs are the first line of defense for a patient; it seems these hospitals are bought and paid for and run by the drug companies .

You'll notice I didn't put "just agree with me" in the subject line; this isn't really solely a vent. I am interested in knowing why these doctors go along with these drugs so easily. They hand them out like candy, and I absolutely I disagree that these drugs are an appropriate treatment for the particular condition of my father. I would love for some doctors or nurses weigh in on this, because my family's respect for the doctors and the medical profession could not be lower; they are drug pushers, not healers or comforters. These drugs destroyed my father's ability to complete rehab and we are considering a lawsuit against the nursing home. But it seems these drugs are everywhere; the hospital and the doctors hand them out like candy. The reason we are rejecting them is because they make him so tired and nonfunctional that if he does by some chance decide to wake up and eat he couldn't possibly express hunger when he can't speak, or doesn't have the energy to sit up because they have made him so tired. I asked when he was on a different floor of the hospital that it be put in his chart we absolutely do not want him to receive mind altering drugs of any type, and yet here they are pushing Zyprexa for gut pain. WTF?!!?!?

Don't even get me started on the idea of hospitalists as doctors. A different doctor sees him every day, and one doesn't talk to the other; the left-hand just doesn't know what the right hand is doing. It seems they don't consult on previous prescriptions or advice, and completely switch up whata previous doctor ordered 24 hours ago, and then the next doctor may switch it to something else. There is no continuity of care and I can't switch hospitals this is a small rural area where my parents live and this is it. You basically can't access true medical care anymore, you can only access drugs.

Edited June 10, 2016 by reefgazer

[Liz CA]

What a horrific thing. Zyprexa when someone has a little twinge?? I work in the mental health field and I am appalled how certain drugs are being pushed on people, even as prn choices.

 

Can he be moved? Can you ask for a patient advocate and discuss this with him/her?

Does he have another MD who could intervene? Second and third opinions?

 

I am sorry to say this is one of the reasons why I try to avoid allopathic medical care at all cost.

But sometimes you are not able to do this as in your Dad's case.

I hope you get some MDs or attorneys here to give you solid advice on what your (and your Dad's) options are.

Edited June 8, 2016 by Liz CA

[Guest]

It's not you.

[hornblower]

Wow, that's appallingly bad care. Sorry you're going through this. 

[JumpyTheFrog]

I listened to a podcast once where the guest was a former pharma rep. He said that pharma companies are able to track which doctors prescribe which drugs so they can make sure their drug dealers sales reps are doing a good job bribing "persuading" doctors to use their drugs. The guest eventually became appalled with the system and quit. I believe he wrote a book about his experiences.

 

I read recently that it is now estimated that drug reactions/botched medical care/unneeded care that leads to a cascade of interventions is now the number 3 killer of Americans (behind heart disease and cancer). It's hard to know exactly how many people die this way because death certificates don't say things like  "died of an infection picked up during a hospital stay for a fall caused by a drug reaction that caused dizziness".

 

On another podcast, the guest was an urgent care doctor. He said he estimates that only 3% of the patients he sees really needed to go to the doctor. The rest come in because they've been conditioned to seek treatment for minor conditions when they'd be better off waiting to see if they heal on their own.

[Innisfree]

Huge hugs.

 

I went through something similar when my father died.

 

He had practiced internal medicine for many decades, going back to the 1960s and 1970s. He had answered the phone in the middle of the night, met his patients at the emergency room when they needed to go in, and made house calls to the folks who needed them. He cared for them in the office, in the hospital, and at home, over decades, and he knew them and understood what they needed.

 

When he needed care, we couldn't begin to match the care he had provided. The only way we could begin to approach it was through his few remaining personal connections within the local medical community.

 

He was both rueful and philosophical about the situation. He said that, as a society, we've opted to provide fantastic specialist care, which no one could have envisioned when he trained in the '50s, instead of generalist care that follows the patient the way he did. He was enthralled and delighted by the procedures which are now possible, and depressed that he couldn't see his own doctor in the hospital. He really hated the idea of hospitalists who lack a long familiarity with their patients.

 

I'm sure there are others who can comment more knowledgeably on why things are the way they are now, but surely insurance and liability play big roles, as well as drug companies. There is so much money in the system, and so little knowledge of the patients as individual people.

 

I wish I had more help to offer. It's so hard to witness. I'll be thinking of you and your father and wishing you both comfort and peace.

Edited June 8, 2016 by Innisfree

[EmseB]

The hospitalist model of care is horrible.  Horrible.  I don't know if I've ever had an encounter with a good one.  I'm sure they are out there, but I have a grudge against all of them.

[eternalsummer]

It's not you.

 

This is how they "take care" of "patients" (I think "inmates" is a better word and the one my grandfather-in-law used to use when he was in a rehab facility or similar) in the memory wing of nursing homes, or sometimes the rehab wing.  They just drug them all up to the eyeballs and call it good.

[Lanny]

First, I applaud you, for trying to get the best possible care for your father. Second, it is my understanding that very few doctors do a Residency in Geriatrics.  Drugs are THE way many things are "treated".  I have P.T.S.D.   I have watched many stories on the evening news from the USA, about how patients in V.A. hospitals are given "Cocktails"  of various drugs. One drug for this, one drug for that, another drug for something else.  My mother was lucky during the last few months of her life. She was in Kaiser Foundation in CA and fortunately, she had one or 2    doctors who did the best they could for her.  I wish I had a solution for you,  but I don't and the only thing I can   suggest is that you try to be very aware of what they are or are not doing and try to keep your dad as comfortable as is possible.  

[fraidycat]

I'm sorry you have to deal with this. :grouphug:

 

I may look to others like the tinfoil hat squad, but I have zero respect or trust for most allopthic medical "care" beyond immediate life and limb saving measures in trauma situations. I say medical care, because it is my opinion that most ** (there ARE a few good ones) doctors wouldn't know what Health care looks like if it bit them in the nose.

 

I do blame pharmaceutical companies. But I equally blame our culture and society. Nobody wants to do the hard work of proper diet, exercise, balance work vs. play, healthy spiritual practices, healthy mindset, etc. None of it is easy, ALL of it is necessary for health. We want the magic pill that solves all our problems, so we keep going to docs looking for the magic pill. Each generation of doctors gets a little further off course with pressures from both sides of the equation - drug company sponsored schools/jobs and magic pill seeking people.

[MotherGoose]

That is completely bizarre to me. I used to work in mental health a long time ago, but when those drugs were in use.

We used to give combative patients Ativan, which has the same effect, but is short acting, like Valium. Not saying your father was combative. So it should be able to knock someone out in a crisis. Zyprexa, at least , was a long acting med. it's a good med, and one that has allowed many people to stay our of psychiatric hospitals and live normal lives. again, it's been a long time since I've been in mental health and I didn't work with the elderly. I do understand the need to quickly sedate some patients, but patients are normally hitting people, or about to, before its time to give that. I would want lots more details about what's going on in these episodes. I'm sorry for you all. I would ask lots of questions.

[Laura Corin]

If you haven't read it, I recommend Being Mortal by Atul Gawande.  It will support your feelings and perhaps give you continued strength.

[Ailaena]

The hospitalist model of care is horrible. Horrible... I have a grudge against all of them.

 

I just wanted to repeat that.

 

Sorry this is happening, op

[Farrar]

They don't care about actually taking care of people at all. Or, rather, they care, of course they do, but the whole model is skewed toward quick fixes, drugs, and toward "alive" as the only measure of care, which, when you're dealing with someone who is either very elderly or actively dying, is a terrible measure.

 

When my father was in the hospital dying, there were a million little things that they could have taken care of relatively easily and just did not. Over and over. And, yeah, I get that he's not going to die because you got his feeding stuff or water wrong. But, come on. We can't cure him so let's do what we can do. We can get the feed right. Sigh. And maybe, hey, getting better care overall will help him fight and be more comfortable. That's why people live longer on hospice care than traditional care.

 

I'm sorry you're dealing with that.

[Farrar]

If at all possible, ask for a palliative care consult. Hospitals don't like to give them (they're expensive for the hospital). Patients and families don't like to ask for them (they associate palliative care with death care only, some think it means "we've given up on dad" or something like that). But palliative care nurses are the people who typically can make poor care like that come to and end. And can help families make better decisions about which treatments to request and which to deny. It's not always as straightforward and "don't resuscitate him."

[PeterPan]

I'm jumping to the end here and see Farrar already said it.  If you think he's within 6 months of dying, you can call hospice.  It's not putting a date stamp on them.  It's just asking for that type of care and the thought in the interventions.  I would definitely call for hospice or whatever other palliative care options you have.

[Katy]

Hospice might be a great idea, but from what you're describing, I would try to find a gerontologist who has privileges at that hospital.  They have a much better understanding of how minor infections and electrolyte imbalances can contribute to dementia, and they will generally listen to families and nurses about what is normal for him, as well as generally supporting whatever the family wants to do in this sort of situation.

 

In the mean time, if he's still admitted, getting the hospital ombudsman involved might be the best option.  I hate to say it, but this is the worst time of year to be in a hospital, at least in the US.  A lot of new doctors are learning and doing anything possible to make a different department responsible for the patients with challenging problems.

[Guest]

We went through an ordeal with my grandmother. What I am convinced saved my grandnother's life is the fact that my sister and cousin are doctors and they were able to communicate with Grandma's doctors and hold them to a higher standard. It really is a sad state of affairs.

[Serenade]

Sadly, I think this kind of treatment is all too common.  Much the same happened to my FIL.  It still makes me angry.

[elegantlion]

They tried to do similar stuff with my dad. He was in and out of the hospital for almost two years before he died. He got to point of saying No to any more drugs. He had one issue with the side effects exacerbated another issue, all "vital" according to the multitude of doctors who rarely got together to discuss how the combinations could affect him. Add that to a primary care who ignored so many symptoms because he was hyperfocused on one issue for years. My mom had to help my dad be firm about it on several occasions. 

[hellen]

If you haven't read it, I recommend Being Mortal by Atul Gawande. It will support your feelings and perhaps give you continued strength.

I'm reading this book right now. It is fantastic but sad. Like you're discovering, we are not set up to deal with the elderly.

[TechWife]

I've been frustrated with the care my parents have received at various times. Not only medication issues, but simple issues of talking loud enough to be heard, similar to what you mentioned. My mom had a terrible experience in rehab earlier this year, too. The administration was terrible, they didn't pay attention to be alarms and numerous other things. They simply acted as if they didn't have a clue what to do with an elderly person. It took days to get her pain under control, and then they were terrible at giving meds on schedule, which made it hard to keep under control. Several administrative problems occurred, with them actually lying to my sister about Medicare coverage in an attempt to get more days billed. I called them on that one because of my experience, but most people don't have that benefit.

 

Don't even get me started on some of the things that happened in the hospital. I've never seen such a passive bunch of healthcare providers in my life. I am blessed to live near nationally ranked research hospitals and the care we have received locally far outpaces the care available to my parents. Yet my parents don't live in a small town. They live in NE Ga. and use metro Atlanta hospitals. The care difference between the teaching/research hospitals and the independent hospitals is striking. I started to write a list of differences up, but was distracted by the goings on in the room. Maybe I'll get back to it one day, we'll likely be back in early July for a day or two, maybe I can get it all out on paper at night.

 

Health care for the elderly is fractured. I'm afraid it is getting more and more,so.

 

Try not to be too worried by the young students, interns and residents starting their rotations, residences and fellowships. I noticed today that they are already starting their orientation classes and they are going out to the floors in little groups of twos and threes, the attending physician a part of the group at the early stage. They just looked like cute little children - I wanted to pinch their cute cheeks! Instead, I said "Welcome to Children's. Let me know if I can help you find any comfort or teaching items for,your patients. " Good students, interns and residents will make it, the attendings will take care those that aren't so good.

[Tenaj]

We went through an ordeal with my grandmother. What I am convinced saved my grandnother's life is the fact that my sister and cousin are doctors and they were able to communicate with Grandma's doctors and hold them to a higher standard. It really is a sad state of affairs.

 

We've had a similar experience.  My father-in-law was in the ICU for several weeks and we were concerned about the level of care he was getting and were having a hard time getting answers from the medical personnel.  

 

We have a family friend who is a M.D. in a foreign country.  She happened to be in the states at the time and she came and stayed for about four weeks, visiting dad everyday, asking questions of the hospital personnel and just sitting in the room as much as she was able and it was amazing how his care level went up.  We suspect that he may not have made it out of the hospital without her presence.

 

But, what about those families that don't have medical personnel available as friends or family members?  I joke with my younger kids that I need one of them to turn into a doctor of some kind but maybe it's not  really a joke anymore.

[Melissa in Australia]

:grouphug:

[magnificent_baby]

(healthcare professional here, though not certified yet, nor trained in acute care)

 

I cannot figure out any reason for the Zyprexa at all. Does he have any history of mental illness? I was also wondering if perhaps you have it mixed up with Bentyl (dicyclomine) which treats gut spasms? Otherwise, that is baffling and I would be livid. 

 

I also agree with you on hospitalists. My grandma died due to miscommunication (or rather NO communication) after being discharged by the hospitalist, and her primary didn't even know she was in the hospital so her usually heart meds were not restarted, and we didn't realize this either. I think the concept makes sense, but can also be a setup for errors. 

 

I would be up there with him as much as you possibly can. Most hospitals (not sure about rural) have a hospital ethics committee. Please ask for a consult with the committee; putting him on an antipsychotic for seemingly no reason is unethical. 

 

Also highly agree with palliative care! Good luck!

[fairfarmhand]

I'm sorry you have to deal with this. :grouphug:

 

I may look to others like the tinfoil hat squad, but I have zero respect or trust for most allopthic medical "care" beyond immediate life and limb saving measures in trauma situations. I say medical care, because it is my opinion that most ** (there ARE a few good ones) doctors wouldn't know what Health care looks like if it bit them in the nose.

 

I do blame pharmaceutical companies. But I equally blame our culture and society. Nobody wants to do the hard work of proper diet, exercise, balance work vs. play, healthy spiritual practices, healthy mindset, etc. None of it is easy, ALL of it is necessary for health. We want the magic pill that solves all our problems, so we keep going to docs looking for the magic pill. Each generation of doctors gets a little further off course with pressures from both sides of the equation - drug company sponsored schools/jobs and magic pill seeking people.

 

YEs, and with insurance changes and moves and the like, having a long standing relationship with a good family doctor can be difficult. Those family doctors who have seen you, your husband, your kids, can say the hard things (Hey, I know you lost your mom last year, and stress is difficult, but you've put on 20 pounds since then, Can we talk about that?")

 

I'm always surprised at how people don't understand that we've chosen a family doctor so everyone sees the same doctor all the time rather than a pediatrician for the kids and a different guy for my dh and I. Our doctor has watched my kids grow up, He knows our family situation and our family history. I've never gotten slack for homeschooling, drinking raw milk, or any of the other non traditional choices we make because he's watched how it's all played out through the years. He knows I'm conscientious about my kids' health without running to him for every little thing and he knows we're a good family trying to do the right thing.

 

Those relationships take years to build but they're invaluable. And I'm dreading the day he retires!

 

[shawthorne44]

We've had a similar experience.  My father-in-law was in the ICU for several weeks and we were concerned about the level of care he was getting and were having a hard time getting answers from the medical personnel.  

 

We have a family friend who is a M.D. in a foreign country.  She happened to be in the states at the time and she came and stayed for about four weeks, visiting dad everyday, asking questions of the hospital personnel and just sitting in the room as much as she was able and it was amazing how his care level went up.  We suspect that he may not have made it out of the hospital without her presence.

 

But, what about those families that don't have medical personnel available as friends or family members?  I joke with my younger kids that I need one of them to turn into a doctor of some kind but maybe it's not  really a joke anymore.

 

I have the number of a woman with lots of medical initials after her name.  She is out of work because she did her job and blew the whistle on her hospital for killing a patient by knowingly putting a MRSA patient in with a non-MRSA patient.  If any of my loved ones are in the hospital I am going to hire her as a personal hospital watchdog.   

Edited June 8, 2016 by shawthorne44

[EmseB]

 

But, what about those families that don't have medical personnel available as friends or family members? 

 

Or even just someone with a phone and google skills and a bit of curiosity and persistence.

 

Of course, when I was working out issues with the hospitalist for a family member I had to be passive and pretend not to know too much or be too forceful about getting the right care, lest I be labeled a "problem" and summarily dismissed as a crazy person with too much access to the internet.  So instead of showing my concern and being direct, I had to be sweet as pie and ask for things in a non-direct way and pretend to be confused about it all so they would explain it to me and hope they would find their mistake as they did so.  It was and still is infuriating to me.

[kroe1]

There was and is a big push to get elderly off of antipsychotic medicines and other sedating medicines because of increased fall risks. It sounds like your father's hospital is not up to speed.

 

But, bottom line, to me it is the massive amount of government intervention and other non-medical entities in healthcare that is destroying it. If we could get rid of those not in healthcare, we could go back to a time when family medicine doctors could afford to see their own patients in the hospital. That is the ultimate continuity of care. Until then, government intervention will continue to escalate and medical errors and stupidity will continue to escalate with it.

 

Your father needs an advocate staying in his room with him at all times. Actually, every patient does.

[Bluegoat]

Huge hugs.

 

I went through something similar when my father died.

 

He had practiced internal medicine for many decades, going back to the 1960s and 1970s. He had answered the phone in the middle of the night, met his patients at the emergency room when they needed to go in, and made house calls to the folks who needed them. He cared for them in the office, in the hospital, and at home, over decades, and he knew them and understood what they needed.

 

When he needed care, we couldn't begin to match the care he had provided. The only way we could begin to approach it was through his few remaining personal connections within the local medical community.

 

He was both rueful and philosophical about the situation. He said that, as a society, we've opted to provide fantastic specialist care, which no one could have envisioned when he trained in the '50s, instead of generalist care that follows the patient the way he did. He was enthralled and delighted by the procedures which are now possible, and depressed that he couldn't see his own doctor in the hospital. He really hated the idea of hospitalists who lack a long familiarity with their patients.

 

I'm sure there are others who can comment more knowledgeably on why things are the way they are now, but surely insurance and liability play big roles, as well as drug companies. There is so much money in the system, and so little knowledge of the patients as individual people.

 

I wish I had more help to offer. It's so hard to witness. I'll be thinking of you and your father and wishing you both comfort and peace.

 

Maybe a bit OT, but I think it really speaks in some ways to the OP - there has been a real decrease in the Family Practice model of medicine.  And from what I have been told, it's much further along in the US than it is where I am in Canada - I even notice it in the way people on WTM talk about their care - they seem to see specialists for almost everything.

 

There is a good reason that the family care model, with a GP who is really your doctor, the gatekeeper, and ideally who also treats other family members, was developed.  My step-day is a GP and my memory of being on-call and such is similar to yours.  My mother's GP, (until her retired) was also the GP of both my grandmothers and grandfather, he delivered me and my siblings and took care of us as kids, he gave me my first pap smear and was my GP until I moved away, and he took care of us if we found ourselves in hospital, doing rounds, usually every day or second day.

 

There are a few reasons that this has changed.  It doesn't tend to work as well when the hospitals are mainly teaching hospitals, they want their residents to get the work.  In the US in particular, (I'm told) people tend to prefer to see specialists, and can refer themselves in most cases - partly this is about cutting costs, but also related to mistaken ideas about experts..  So no one is really in charge of their care overall, keeping an eye out. 

 

Also though, especially in small places, fewer doctors are willing to work the hours that make it work. I think this is in part cultural, but also it may relate somewhat to the increase in women doctors who on average tend to work fewer hours.  THat model tends to mean a need for on-call rosters or duty clinics, and it means keeping up hospital privileges, possibly in more than one hospital, which has a real administrative burden.  Doctors in those systems also often work ER shifts.  All of which is to say, its long and sometimes unpredictable days, and especially in smaller towns it can be a problem.

[gaillardia]

:grouphug:  :grouphug:  :grouphug:

that all sounds very upsetting and I extend my sympathies to anyone here who has had to or are having to deal with this type of situation.

It hurts. It's confusing. 

 

[Reefgazer]

No, he can't be moved because my parents are rural and this is the only hospital for quite a bit of miles. For some reason, all the doctors are hospitalists and the family doctors don't seem to come in the hospital anymore.

What a horrific thing. Zyprexa when someone has a little twinge?? I work in the mental health field and I am appalled how certain drugs are being pushed on people, even as prn choices.

 

Can he be moved? Can you ask for a patient advocate and discuss this with him/her?

Does he have another MD who could intervene? Second and third opinions?

 

I am sorry to say this is one of the reasons why I try to avoid allopathic medical care at all cost.

But sometimes you are not able to do this as in your Dad's case.

I hope you get some MDs or attorneys here to give you solid advice on what your (and your Dad's) options are.

[Reefgazer]

Yes, this is what we have had to do ask every. single. day. What drugs they plan on giving him, what his treatment is, what the plan is, etc. today, they actually suggested morphine for diarrhea pain after I rejected the Zyprexa, and it was only minor diarrhea pain. It's like killing flies with a machine gun.

 

First, I applaud you, for trying to get the best possible care for your father. Second, it is my understanding that very few doctors do a Residency in Geriatrics. Drugs are THE way many things are "treated". I have P.T.S.D. I have watched many stories on the evening news from the USA, about how patients in V.A. hospitals are given "Cocktails" of various drugs. One drug for this, one drug for that, another drug for something else. My mother was lucky during the last few months of her life. She was in Kaiser Foundation in CA and fortunately, she had one or 2 doctors who did the best they could for her. I wish I had a solution for you, but I don't and the only thing I can suggest is that you try to be very aware of what they are or are not doing and try to keep your dad as comfortable as is possible.

[Reefgazer]

Oh, my dad was combative, which is why he was given the SeroqueI. He started swatting and swearing at people, but is weak as a bird. Really, if they had written down what they wanted him to do he probably would've been fine because he can't hear when they talk to his face. I disagree that drugs are the proper way to handle an elderly patient, no matter if they are violent, because they are weak as kittens even at their most combative and because understanding their medical situation and patiently dealing with it would accomplish what they wanted. This is especially true since the Seroquel has a black box warning against it for a man of my dads age and condition. But they are understaffed and that was an easy answer for them, and the drug was administered to my dad without regard to the medical effects. Anyway, after he got back to the hospital completely nonfunctional because of the Seroquel they hit him with Zyorexa and he and he went into spasms and seizures. Then they hit them with morphine in Haldol and the seizures but it just got worse, so finally they put him an Ativan and sedated him the ICU and it did stop the muscle seizures and spasms. I sometimes wonder where these people got their medical degree. If they can't handle elderly combative patients, they need to seek another field of work.

 

That is completely bizarre to me. I used to work in mental health a long time ago, but when those drugs were in use.

We used to give combative patients Ativan, which has the same effect, but is short acting, like Valium. Not saying your father was combative. So it should be able to knock someone out in a crisis. Zyprexa, at least , was a long acting med. it's a good med, and one that has allowed many people to stay our of psychiatric hospitals and live normal lives. again, it's been a long time since I've been in mental health and I didn't work with the elderly. I do understand the need to quickly sedate some patients, but patients are normally hitting people, or about to, before its time to give that. I would want lots more details about what's going on in these episodes. I'm sorry for you all. I would ask lots of questions.

[Reefgazer]

Yes, we did talk about palliative care, but I didn't see the consultant. I probably should have. But I have been up here for three weeks and am heading back to Virginia tomorrow to tie up loose ends I left hanging down there, so I'll suggest that my sister do that. My mom is so upset she is non functional and she can't do it. Dad handled *everything* before he went into the hospital and she is so lost. She actually tried to get money out of the bank yesterday without writing an account number in the withdrawal slip because "daddy just handed me the slip and I gave it to the teller and she knows how much to give him because he got the same amount out every month." She was so mad at me because I told her she'd need an account number. It was actually quite funny looking back, but this is how helpless my mom is with all this.

If at all possible, ask for a palliative care consult. Hospitals don't like to give them (they're expensive for the hospital). Patients and families don't like to ask for them (they associate palliative care with death care only, some think it means "we've given up on dad" or something like that). But palliative care nurses are the people who typically can make poor care like that come to and end. And can help families make better decisions about which treatments to request and which to deny. It's not always as straightforward and "don't resuscitate him."

[Reefgazer]

He has no history of violence or mental illness, except for the combative stuff at the rehab hospital. But he was a pain in the ass before he moved to rehab because he wanted to walk and kept trying to escape from the chair they had locked him into to prevent him from walking and falling. So he spent a good deal of time swearing at the tray locking him in, asking me for his pliers and Alan wrench to escape, and then finally he made a rope of the privacy curtain in order to haul himself out of the chair. That earned him detention in front of the nurses station where he could be watched. But those things were not combative exactly, they were just pain in the ass-ish. Truthfully, when my dad's being a pain in the ass it means he's feeling better. When he's docileand quiet, he's really sick.

 

No, the med recommended was Zyprexa and I didn't get it mixed up. One of the nurses thought I was mistaken and looked it up, and informed me it isn't a pain killer (which I already knew), and then quietly told me she disagreed with hospital policy on psychotropic meds, but she would be in major trouble if they heard her say that.

 

 

 

(healthcare professional here, though not certified yet, nor trained in acute care)

 

I cannot figure out any reason for the Zyprexa at all. Does he have any history of mental illness? I was also wondering if perhaps you have it mixed up with Bentyl (dicyclomine) which treats gut spasms? Otherwise, that is baffling and I would be livid.

 

I also agree with you on hospitalists. My grandma died due to miscommunication (or rather NO communication) after being discharged by the hospitalist, and her primary didn't even know she was in the hospital so her usually heart meds were not restarted, and we didn't realize this either. I think the concept makes sense, but can also be a setup for errors.

 

I would be up there with him as much as you possibly can. Most hospitals (not sure about rural) have a hospital ethics committee. Please ask for a consult with the committee; putting him on an antipsychotic for seemingly no reason is unethical.

 

Also highly agree with palliative care! Good luck!

Edited June 9, 2016 by reefgazer

[Reefgazer]

I think there's a big push to use these Psychotropic medications because they are basically chemical lobotomies that make people very pliable and immobile, and that makes it easier for the overtaxed staff.

 

You are absolutely right about advocate staying in his room. After that Seroquel slam, I slept in his room at the foot of his bed, guarding him like some kind of junkyard dog so they couldn't pump him full of any more drugs. Finally they realize my family and I were not going to give in to the drug pushers and put a written note in the chart that he's not have any psycho medications without our approval.

 

There was and is a big push to get elderly off of antipsychotic medicines and other sedating medicines because of increased fall risks. It sounds like your father's hospital is not up to speed.

 

But, bottom line, to me it is the massive amount of government intervention and other non-medical entities in healthcare that is destroying it. If we could get rid of those not in healthcare, we could go back to a time when family medicine doctors could afford to see their own patients in the hospital. That is the ultimate continuity of care. Until then, government intervention will continue to escalate and medical errors and stupidity will continue to escalate with it.

 

Your father needs an advocate staying in his room with him at all times. Actually, every patient does.

[shawthorne44]

Yes, this is what we have had to do ask every. single. day. What drugs they plan on giving him, what his treatment is, what the plan is, etc. today, they actually suggested morphine for diarrhea pain after I rejected the Zyprexa, and it was only minor diarrhea pain. It's like killing flies with a machine gun.

 

 

In college my boyfriends mother owned a nursing home.  I was sitting around the kitchen table with the family and she started to talk about the drugs that the doctors would give to people when they were old.  She said that the doctors attitude seemed to be, "Well, old people take many long term drugs, if someone old becomes addicted, who will notice or care?  And the patient is quiet."    I think at the time it was a lot of narcotics.  She had a bottle larger than the Sam's size bottle of Motrin except it was a strong Narcotic.  When someone died she'd confiscate their drugs and then add them to the supply of whoever was taking the same thing.  

[MaeFlowers]

I'm sorry you are going through this. I just got back from spending two weeks with my parents. My mom was in the hospital with pneumonia, dehydration and a uti. I have to agree that I was less than impressed (to put it lightly). She, too, left the hospital very weak. As in she could walk fine when she went in but not when she came out (she couldn't walk at all). In fact, one day, I was looking at the board and her "goal" for the day was to have her up and walking. It never happened. When one of the nurses brought her a pill and she asked what it was, they refused to tell her and then told "you'll be sorry" if she didn't just take it. The same nurse cussed her out for messing herself from the antibiotic induced diarrhea. They talked her like she was a idiot. It drove me insane.

I have to say that most of the nurses were kind. It was really only one who was awful. But, I'm still frustrated. I live so far away and my dad is the only one who can go to bat for her on a daily basis and he is frustrated. She takes so many meds. Most of them are useless and unnecessary. (I'be looked them all up and know her medical conditions and history.) Some of them have serious warnings for mixing them. Some cause some of the issues she has been having. But, when you question the doctors they treat you like your crazy. When you ask the pharmacist, they play dumb. She take smedicine for things she doesn't have and they ignore problems she does.

Anyway, I didn't mean to vent so much but I wanted to say I understand your frustration. I'm not sure it's so new, though. I started giving up on drs about ten years ago.

 

I wanted to add...

Two things I that have been really driving me crazy are th use of antidepressants and sleep aids. So many members of my family have had antidepressants added to their list. They are given miniscule amounts that can't possibly be effective and without reason. I understand that depression can be common in elderly patients but it shouldn't be a standard treatment for anyone over the age of 65.

Second, hospitals giving sleep aids. Why in the world do they have to wake you up to give you a sleeping pill? And don't get me started on Ambien. If they tried to give me or anyone I knew that pill in the hospital, they would see a whole new level or cray-cray.

Edited June 9, 2016 by MaeFlowers

[Reefgazer]

I'm sorry that you are experiencing the same thing; it is utterly exhausting and the only thing that has worked for us since the original poisoning is just saying "no" - forcefully, repeatedly, every day, to anyone who suggests unneeded medication. I have gotten to the point where I don't care if they think I'm stupid or crazy because, well, I think their medical degree is from Drug Pushers R Us.

 

I do have to say most of the nurses and CNAs who are caring for my dad work their tails off and are wonderful; there are only one or two that need to be slapped upside the head and have their licenses pulled because they're in the more meds are better camp with most of the doctors.

 

I'm sorry you are going through this. I just got back from spending two weeks with my parents. My mom was in the hospital with pneumonia, dehydration and a uti. I have to agree that I was less than impressed (to put it lightly). She, too, left the hospital very weak. As in she could walk fine when she went in but not when she came out (she couldn't walk at all). In fact, one day, I was looking at the board and her "goal" for the day was to have her up and walking. It never happened. When one of the nurses brought her a pill and she asked what it was, they refused to tell her and then told "you'll be sorry" if she didn't just take it. The same nurse cussed her out for messing herself from the antibiotic induced diarrhea. They talked her like she was a idiot. It drove me insane.

I have to say that most of the nurses were kind. It was really only one who was awful. But, I'm still frustrated. I live so far away and my dad is the only one who can go to bat for her on a daily basis and he is frustrated. She takes so many meds. Most of them are useless and unnecessary. (I'be looked them all up and know her medical conditions and history.) Some of them have serious warnings for mixing them. Some cause some of the issues she has been having. But, when you question the doctors they treat you like your crazy. When you ask the pharmacist, they play dumb. She take smedicine for things she doesn't have and they ignore problems she does.

Anyway, I didn't mean to vent so much but I wanted to say I understand your frustration. I'm not sure it's so new, though. I started giving up on drs about ten years ago.

Edited June 9, 2016 by reefgazer

[Reefgazer]

I think it was so easy to notice with our dad because he only takes two medications, one of which is Coumadin and seems to have few side effects on him.

 

In college my boyfriends mother owned a nursing home. I was sitting around the kitchen table with the family and she started to talk about the drugs that the doctors would give to people when they were old. She said that the doctors attitude seemed to be, "Well, old people take many long term drugs, if someone old becomes addicted, who will notice or care? And the patient is quiet." I think at the time it was a lot of narcotics. She had a bottle larger than the Sam's size bottle of Motrin except it was a strong Narcotic. When someone died she'd confiscate their drugs and then add them to the supply of whoever was taking the same thing.

[MaeFlowers]

It's just so sad that not only can we not trust doctors, we have to fight them. Their job is to heal and they take an oath to do no harm. What happened to that? 😔

[TranquilMind]

Right there with you regarding "hospitalists".  What a joke.

 

It's a disaster.  When my mother was hospitalized, she ended up on so many drugs that no one even knew what they were for.    Her own family doctor couldn't figure out when he was finally "allowed" to see her afterward; he was no longer allowed to visit her in the hospital. 

 

I learned you had better be there 24/7 to protect the patient. 

[TranquilMind]

I'm sorry you are going through this. I just got back from spending two weeks with my parents. My mom was in the hospital with pneumonia, dehydration and a uti. I have to agree that I was less than impressed (to put it lightly). She, too, left the hospital very weak. As in she could walk fine when she went in but not when she came out (she couldn't walk at all). In fact, one day, I was looking at the board and her "goal" for the day was to have her up and walking. It never happened. When one of the nurses brought her a pill and she asked what it was, they refused to tell her and then told "you'll be sorry" if she didn't just take it.

 

What?  Oh, hell no.  They refused to tell her?  That's when it is time to walk out (if they haven't drugged you too much to do so).  Or at least go straight to the top with a complaint and a potential lawsuit. 

 

[TranquilMind]

What a horrific thing. Zyprexa when someone has a little twinge?? I work in the mental health field and I am appalled how certain drugs are being pushed on people, even as prn choices.

 

Can he be moved? Can you ask for a patient advocate and discuss this with him/her?

Does he have another MD who could intervene? Second and third opinions?

 

I am sorry to say this is one of the reasons why I try to avoid allopathic medical care at all cost.

But sometimes you are not able to do this as in your Dad's case.

I hope you get some MDs or attorneys here to give you solid advice on what your (and your Dad's) options are.

 

I try to avoid it too, but it is very hard to do with elderly people, as bad things start happening. 

 

I do very much wish I had not taken my mom to the hospital for the last time though.  Lots of pain and unnecessary care for no benefit. 

 

[TranquilMind]

He has no history of violence or mental illness, except for the combative stuff at the rehab hospital. But he was a pain in the ass before he moved to rehab because he wanted to walk and kept trying to escape from the chair they had locked him into to prevent him from walking and falling. So he spent a good deal of time swearing at the tray locking him in, asking me for his pliers and Alan wrench to escape, and then finally he made a rope of the privacy curtain in order to haul himself out of the chair. That earned him detention in front of the nurses station where he could be watched. But those things were not combative exactly, they were just pain in the ass-ish. Truthfully, when my dad's being a pain in the ass it means he's feeling better. When he's docileand quiet, he's really sick.

 

No, the med recommended was Zyprexa and I didn't get it mixed up. One of the nurses thought I was mistaken and looked it up, and informed me it isn't a pain killer (which I already knew), and then quietly told me she disagreed with hospital policy on psychotropic meds, but she would be in major trouble if they heard her say that.

 

 

 

 

Good Lord.   This is really scary.  I went through all this in previous decades so every patient wasn't automatically drugged up in those days. 

 

[Laura Corin]

I've not heard the term 'hospitalist' before - that may be to do with the evolution of hospital care in the UK.  Before the founding of the NHS in the 40s, hospitals were for poor people only, and the doctors often worked there pro bono.  If you had money, you were treated at home (including operations) or in private nursing homes.  So there wasn't a tradition of GPs following their patients into hospitals.  I believe that the split remained after the founding of the NHS - currently your GP refers you to a specialist at the hospital, or you are admitted as an emergency and cared for within the hospital.  Usually your GP receives reports about your treatment, and care is transferred back after you leave hospital.  The exception would be if you need continued specialist care, in which case you would see both the specialist at the hospital and your GP.

 

The split of course means that information can be lost, but on the other hand, the integrated NHS system means that - with luck - information can be tracked down.  For example, my mother saw a specialist who wanted to perform a CT scan.  I said that I thought she had had one in a different town (in England, rather than Scotland where she now lives) before she moved.  It was easy for him to request the results and avoid a repeated test.

 

OP - I'm sorry you are going through this.

[TechWife]

I think there's a big push to use these Psychotropic medications because they are basically chemical lobotomies that make people very pliable and immobile, and that makes it easier for the overtaxed staff.

 

You are absolutely right about advocate staying in his room. After that Seroquel slam, I slept in his room at the foot of his bed, guarding him like some kind of junkyard dog so they couldn't pump him full of any more drugs. Finally they realize my family and I were not going to give in to the drug pushers and put a written note in the chart that he's not have any psycho medications without our approval.

 

 

One thing to consider is to ask for their policy on the use of chemical restraints. It would be interesting to see if they have one. I know there are policies against using them in nursing homes. Psychotropic medications can be used as part of a full care plan for psychiatric patients but they are not to be used to control behavior in other patients. Instead, a full care plan should be developed that works to alleviate the problems. Chemical restraints should only be used if the person is a danger to themselves or others. 

[TechWife]

I'm sorry you are going through this. I just got back from spending two weeks with my parents. My mom was in the hospital with pneumonia, dehydration and a uti. I have to agree that I was less than impressed (to put it lightly). She, too, left the hospital very weak. As in she could walk fine when she went in but not when she came out (she couldn't walk at all). In fact, one day, I was looking at the board and her "goal" for the day was to have her up and walking. It never happened. When one of the nurses brought her a pill and she asked what it was, they refused to tell her and then told "you'll be sorry" if she didn't just take it. The same nurse cussed her out for messing herself from the antibiotic induced diarrhea. They talked her like she was a idiot. It drove me insane.

 

 

Please call the hospital and report this to the patient advocate's office. They really do need to know so that it can be addressed with the nursing staff. Also, it will help them determine if there is a pattern with any particular nurse or unit in the hospital. The hospital administration should take this very seriously. 

[TechWife]

...currently your GP refers you to a specialist at the hospital, or you are admitted as an emergency and cared for within the hospital.  Usually your GP receives reports about your treatment, and care is transferred back after you leave hospital.  The exception would be if you need continued specialist care, in which case you would see both the specialist at the hospital and your GP.

 

The split of course means that information can be lost, but on the other hand, the integrated NHS system means that - with luck - information can be tracked down.  For example, my mother saw a specialist who wanted to perform a CT scan.  I said that I thought she had had one in a different town (in England, rather than Scotland where she now lives) before she moved.  It was easy for him to request the results and avoid a repeated test.

 

OP - I'm sorry you are going through this.

 

A hospitalist is a physician who takes care of people while they are in the hospital. If specialists are needed, they are there as well. It sounds similar to what your system is like. 

 

Electronic medical records are just getting started here in the US. This will make it much easier for patients and their doctors to find information on past illnesses and procedures.