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Adventures in Elder Care
Old 10-14-2006, 09:51 AM   #1
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Adventures in Elder Care

Thought I'd pass on this "day in the life" type story.

I'm here at my sister's in Tacoma helping to take care of my 90-year-old Mom.

Yesterday she had an appointment at 11 at "Group Health." It slipped my mind, possibly because I was trying to intersperse solving computer network problems with medications, etc, but mostly 'cause I just forgot.

Anyway, at 10:55 DW notices the appointment on the calendar, and it's off to the races (the place is 20 minutes away). Task one is to figure out how the portable oxygen machine works. It's not complicated, but there are no instructions on the machine (liability reasons??). Quick call to sister in New York, and I got that working.

Now, I had planned to get the address of Group Health ahead of time, and figure out how to get there (I'm not from around here). But there was no time for that, and Mom says "Oh, I've been there a thousand times, I know exactly how to go."

It wasn't until about 15 instructions ("Go left here," "Turn here") that I realized that we were going in a random walk pattern. In and out of the city, and definitely not making any progress, but she was always very sure of herself.

So I finally decided to ignore further instructions, and head for M street, which she had said it was on (not true, it turns out). I turned left even though she said right, went two blocks, and all of a sudden, like the parting of the clouds, there it was, Group Health.

We got there an hour and a quarter late, but were able to see the doctor anyway. Worse was that we missed the hospice housecleaner appointment.

But it wasn't real stressful, since the appointment wasn't that critical. We all had a laugh about it later.

So anyway, that's the news from eldercare land.
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Re: Adventures in Elder Care
Old 10-14-2006, 11:04 AM   #2
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Re: Adventures in Elder Care

It was good of them to see her even after arriving 90 minutes late.

I often am troubled about trying to accommodate such situations. Do you accommodate the late patient and thereby make 3 or 4 or 8 punctual patients wait? Or do you reschedule the late patient to another date and thereby see your other timely patients on time? It can be tricky. I'd add that I run on time 90% of the time.

Anyhow, yours is a good anecdote about how time and energy-consuming it can be to care for an impaired parent even without a crisis at hand.
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Re: Adventures in Elder Care
Old 10-14-2006, 12:28 PM   #3
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Re: Adventures in Elder Care

Quote:
Originally Posted by Rich_in_Tampa
I'd add that I run on time 90% of the time.
See, that's your problem. You're assuming that the Group Health people even noticed she was late.
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Re: Adventures in Elder Care
Old 10-14-2006, 01:19 PM   #4
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Re: Adventures in Elder Care

I think most health care providers understand the difficulty of getting the frail elderly to the clinic and build some cushion in their schedules right around the noon hour. Other patients were more quickly seen, I doubt that it set back the schedule.

A couple months ago I took my Mom to see her MD. The handi-cab didn't show on time. To make her appointment I wheeled her to the clinic, about 10 blocks. Life is a lot more complicated when you are caring for the sick or disabled.

corrected typo
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Re: Adventures in Elder Care
Old 10-14-2006, 01:24 PM   #5
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Re: Adventures in Elder Care

Quote:
Originally Posted by Rich_in_Tampa
It was good of them to see her even after arriving 90 minutes late.

I often am troubled about trying to accommodate such situations. Do you accommodate the late patient and thereby make 3 or 4 or 8 punctual patients wait? Or do you reschedule the late patient to another date and thereby see your other timely patients on time? It can be tricky. I'd add that I run on time 90% of the time.

Anyhow, yours is a good anecdote about how time and energy-consuming it can be to care for an impaired parent even without a crisis at hand.
With my doctor, if I showed up 90 minutes late it'd be just about time to go in back for the appointment!
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Re: Adventures in Elder Care
Old 10-14-2006, 02:28 PM   #6
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Re: Adventures in Elder Care

Quote:
Originally Posted by Brat
I think most health care providers understand the difficulty of getting the frail elderly to the clinic and build some cushion in their schedules right around the noon hour. Other patients were more quickly seen, I doubt that it set back the schedule.
Indulge me a moderate rant:

Not that simple. Some days go as you describe and yes, most I know -- including myself-- try to accommodate the best we can. If you are lucky, a no-show or real quick appt rescues you. I do understand the difficulty of transporting the frail, etc. -- many of my patients are in that condition. Yet some have figured out to leave home earlier or whatever, and rarely arrive late while others routinely do so. And of course, it can happen to anyone once in a while -- that's life.

But many days you are struggling to keep up. Later scheduled patients have deadlines, other tests or appts to make it to, need to catch their ride, you name it. By making 5-10 people 30 minutes late in order to accommodate one late patient (however worthy the reason) can be tricky. Doctors who routinely accommodate every patient no matter how late are often the same doctors who always run late. If you are a patient who generally arrives on time, that can be frustrating, understandably.

We haven't even discussed the add-ons, emergencies, important phone calls etc. Years ago, the "system" (meaning fewer patients per day where "productivity" was less a priority ), had more wiggle room than today, alas.

I have found busy and chaotic clinic days to be quite trying for me and my patients. I have coped with that by generally running on time, rescheduling late patients (e.g. late by the length of their appt) where this does not create undue hardship or risk, and building in a "hold" where I can (almost always taken the same day). Other times I agree to see them but only if they wait til the end of the session, which then lengthens my and my staff's day. OK now and then, but not daily.

For every complaint about having to reschedule I'd bet I get 3 compliments about how much they appreciate routinely being seen on time. Another consideration is that time-pressure is a factor which can lead to errors. I am more comfortable staying focused and reasonably on time so I can give each patient the attention they deserve rather than juggling irritated patients all day.

So, we do our best hoping to make everyone happy but sometimes are forced to inconvenience one in order to accomodate many. It's so nice when patients understand this and graciously acknowledge their lateness and agree to reschedule, appreciating your efforts to be there for them at the appointed hour.

Just sharing the other side of the coin. Bloated schedules are one of the things I won't miss after FIRE .

Glad it worked out for Al and Mom that day.
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Re: Adventures in Elder Care
Old 10-14-2006, 02:48 PM   #7
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Re: Adventures in Elder Care

Quote:
Originally Posted by Rich_in_Tampa
Bloated schedules are one of the things I won't miss after FIRE .
On the good side of medical scheduling, I've had two appointments with an orthopedic surgeon for the usual poke-it-and-prod-it business.

But when I needed a prescription for the orthopedic knee braces and when I later had a question about NSAID dosage, both times I was able to send him a fax. Both times I got a phone reply within 24 hours. He didn't bill me for a copay either time.

I don't know how a nice guy like that stays in business, but he'll be working a long time!
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Re: Adventures in Elder Care
Old 10-14-2006, 04:27 PM   #8
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Re: Adventures in Elder Care

My orthopod (not the 90 min late doc mentioned above) was routinely 3 to 4 hours late. His solution? Offer to reschedule the patients. I wish I could bill him for my time. Imagine how much is being lost with 15-20 patients sitting in his office for 3-4 EXTRA hours. It's a travesty!
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Re: Adventures in Elder Care
Old 10-14-2006, 04:42 PM   #9
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Re: Adventures in Elder Care

DH and I had a great dr, we had to stop seeing her because she was always running 1.5 to 2.5 hours late. Dh has HBP, it was always high when she saw him and he finally told her it was from him getting so pissed off waiting to see her. Later I found out she lost so many patients because waiting room times that she made some changes but a friend that still goes to her said it didn't change much.
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