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Friday, October 16, 2015

Health Care Conundrum

There is a quandary that comes up frequently for me as a visiting nurse.  It occurs when a patient has been hospitalized for a life threatening illness, recovers and is sent to a rehab/skilled nursing facility to convalesce. When discharged home the patient is given the meds that remain from a 30 day supply used in the SNF, but no prescriptions.  It is expected they will see their own doctor to get their prescriptions.  Usually, these patients have not had a primary care doctor prior to this event.

I call and plead with the physician to call in scripts to the pharmacy so the patient will not suffer a relapse.   Most insist on seeing the patient first, I can understand that. What frustrates me most, is when the patient sees a provider who is not the pcp, and they do not write the patient any scripts. The patient is told to get them from the PCP. The number one reason patients get re-hospitalized is not taking their medications correctly or in this case not at all.

This reminds me of our yearly safety teaching.  Every year we are asked "Who is responsible for safety?" The answer is " everyone".  So I ask, who is responsible for making sure there is continuity of care? All of us. If health care providers truly care about improving outcomes and lowering the cost of medical care, they need to stop passing the buck. There has to be a change in the culture of medicine that puts all the responsibility on the primary physician. No patient should be left behind.  No patient should have to navigate our complicated web of health care alone.  Everyone is accountable. Everyone should treat the patient in front of them as if they are their primary patient.

This happens in nursing, too. How often have patients been told they have to wait for their assigned nurse to minister to their needs? Too often.  It also happens in home care. Nurses visiting patients as a substitute for the primary nurse sometimes leave important tasks for the primary nurse to complete. This is not the expectation and holding those accountable has proven difficult.

What is the solution? I think we need to hold each other accountable and making the commitment to putting the patient first and foremost.  When we do all we can to assure the patient is going to be successful in mastering their health challenge, patient satisfaction will rise, emergency care will decrease, and costs will become more manageable.

Its not difficult, and its the right thing to do.

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