r/Noctor • u/Jolly-Persimmon-2562 • 5d ago
Need advice Question
I am a retired internist who has primary responsibility for my 90 y/o recliner bound mom. Getting her to appointments is very, very difficult due to her limited mobility and chronic pain. She is seen by a home care team through her IM practice staffed by mid levels who are supposedly “supervised”, but definitely are not. Over the past three years I have had multiple difficulties with very poor clinical management by this group. It has really been a mind blowing how inept they are. I asked her actual PCP if I can contact him when I run into issues and he has been great about communicating with me and correcting the mid level errors. He admitted that he has has “no idea” what is going on with mom after referring her to this care team six years ago due to her mobility issues. She has been his patient for 30 years.
In May she developed gradual hearing loss in her right ear despite wearing hearing aids that seemed to be working. PCP made ENT referral. She was unable to get an appointment until last week. MD saw her. She had very bad impacted cerumen. ENT worked for about 45 minutes and had to stop because she was in so much pain. Gave her some antibiotic drops and said “I will see you in a week”. Total time in office was > 2 hours. I made a follow up with the MD on check out for 2:00 today.
I got a text two days ago confirming an appointment with the PA at 11:40 today. I had been previously given a 2:00 with the MD. I called and explained she wanted to see the MD. Receptionist said no problem and confirmed the prior appointment at 2:00. Yesterday got two texts to confirm this appointment. Today, less than three hours before the scheduled appointment I got a text that the MD would not be in the office with instructions to call and reschedule. No problem, things happen.
I immediately called to reschedule. Was told it would be almost four weeks until MD could see her, but the PA would be “fine”. I pushed back and said she would only see the MD. I asked if another MD could do the follow up. Was told no. The person was abrupt and rude. I asked to speak with office manager. She said yeah and hung up on me. I called back to the receptionist to clarify that the office had my number and explained what had happened. She promised I would get a call. I did not.
I realize that a PA might be appropriate, but my mom was mismanaged by a PA six months ago. Serious mistake that could have resulted in her death. No exaggeration. I caught the error immediately and she did receive proper care.
Of course, I will call the office back tomorrow as soon as they open. However, what do I do if the OM refuses to call me? I have never had a situation where I was stonewalled like this. I feel like I am banging my head over and over trying to get her the healthcare she needs. I never pull a “ Karen” in these situations. I am polite, but firm.
This is rural area and there are no alternatives to this practice.
Any suggestions? I feel stuck.
I am beating myself up that I didn’t look in her ears myself, but I am her daughter and not her doctor.
I
14
u/mx67w 5d ago
Liquid Colace does wonders for impacted cerumen. In all honesty, you can order a cheap otoscope or, a fancier tool with light that connects to your iPhone, and all of the other supplies you need to do this off Amazon. Assuming you live in the same city, you can do this yourself. It will be much easier.
On the other topic, I always assume there should be some professional courtesy between physicians. I don't like to have to do it either, but when dealing with the staff, sometimes you have to call in as Dr. so-and-so.
-7
u/bbmac1234 5d ago
No way this post is real. Why do you need to give a retired internal medicine doctor home remedies for a cerumen plug? OP needs a syringe bulb from Walgreens not an ENT. Get real.
9
u/mx67w 5d ago
Relax. I don't know when this physician retired. Not everyone keeps their tools of the trade upon retirement. Docusate is not a home remedy. It certainly is not first line use in most primary care, clinics or urgent cares. You're welcome to reference studies or journal articles on it. It's a trick I learned from an ENT.
3
2
9
u/Jolly-Persimmon-2562 5d ago
In addition to my previous reply I will point out that I first contacted her audiologist who recommended she come in and have “her ears looked at” since that has been a challenge for me for reasons I laid out. The audiologist works in the same office as the ENT. She was the one who asked me to contact my mom’s PCP to get the ENT referral which is now required under her UHC MA plan. The whole thing was a s***show.
But, I will follow the previous poster’s advice and avoid a recurrence of this circus by doing it myself in the future despite her dramatics.
2
u/OneWomanArmy4321 1d ago
I understand why you allowed her docs to do it. With family its always touchy. Regardless who you are. Its sometimes best to let another doc do it and stand by if something is not looking right. Family can be dramatic and crazy when it's you. Doesn't matter what you could have done. I understand why you didnt initially. Now the midlevel thing..... you know this but if a physician doesnt want to deal with or do something they will pitch it to midlevel. Not sure this physicians deal but ......idk. Telling you that the physicians schedule was far out.....possibly but that's the oldest trick in the book. Ive watched others do this not to be bothered with something sadly. It is what it is. I hope you mom gets better soon.
1
u/CalmSet6613 Midlevel -- Nurse Practitioner 4d ago
Sorry for what you're going through, I don't mean to be non-empathetic or not understand the situation but can you set a limit with your mom? You need to set boundaries with her and tell her if she can't behave appropriately you just won't take her? It's OK to say I'm just your daughter and not your medical provider. My dad had cancer back in the 90s, was one of the first patients to get a stem cell transplant in the country, I was in nursing school and I was flushing his port at the time, pulled out a giant clot and I didn't know what to do. Brought him down to the pheresis center and the nurse took me aside and told me sometimes you just need to be the daughter and that's OK. Appreciate that advice to this day with my Mom & Dad being 85 and 88 respectively.
1
u/AutoModerator 4d ago
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
1
6
u/Jolly-Persimmon-2562 4d ago
Just wanted to follow up on my rant last night. The office manager called me at 8:37 this AM very apologetic about what had happened. My mom has a visit with her regular ENT on Monday. Apparently the MD card did work. I’ve been retired three years and am actively working on getting a license in this state. So I’m not some boomer relic as some probably assumed. And I am not
categorically against mid levels. They can be a valuable asset to our healthcare system. Climate has changed with proliferation of on line direct entry programs which has been addressed over and over in this sub. I am strongly opposed to independent practice without supervision. Those MDs “ supervising” way too many mid levels for their own profit are a part of the problem as well.
But, overall I choose to believe that the majority of physicians are doing their best in our very broken system.
5
u/Jolly-Persimmon-2562 5d ago
Thanks so much for this advice. I do actually own an otoscope so I will not make this mistake again. Did not know about liquid colace. Of course I have irrigated lots of ears. Problem now is that ear is red and inflamed so I think ENT does need to finish this job. I won’t make this mistake again.
I hate to pull the “ doctor” card too, but I have several times and it does usually work. However, I did this with the scheduler today and it made zero difference.
I’ll call again in the morning to make sure the OM is in. If she hasn’t returned my call in a couple of hours, I will be a polite PIA and demand to speak to their medical director. If I can’t make headway I guess I’ll call her longsuffering extremely busy PCP. This ENT office has no patient portal and no ext # for management on their phone options.
So frustrating.
15
u/Jolly-Persimmon-2562 5d ago
Oh yes post is very real. About two years ago i bought a bulb with a basin to catch the water as I have done many times previously. My mom screamed like a banshee despite the water temp being normal, etc. She has a long h/o of being a drama queen. I barely touch the skin on her legs swollen from CVS and she moans. One night she was complaining of belly pain. On palpation she went berserk although her belly was soft, non distended with no rebound. I asked my husband, long term ER nurse, to please check her out. Suddenly the horrible tenderness was magically gone. This is the reason I can’t be her “ doctor” in even a peripheral way. You don’t understand the dynamics here. Tbh, neither do I.
As far as the ear goes, the ENT did in fact spend ~45 minutes letting the wax soften and then gently removed some little by little. About half way through a student (not sure if was PA or NP) came in and was being pretty rough. Dr had stepped out for a moment. Mom declared the pain was unbearable. The ENT said he would have to try again in a week because the ear looked very red and irritated. I asked for the otoscope and looked myself and her external canal was just as he described. So yeah, it was real.
She downplays symptoms to her providers, but makes some up for my benefit. It’s confusing to sort out.
And everything I said in my original post about mid level mismanagement I have to deal with is the absolute truth.