What to do about Grandpa.
As the only sentient life on this planet, there are a few topics we humans refuse to think about
1 -Our own inevitable death,
2- Our parents having sex
3-What to do about Grandpa!

Grandpa is now 89 years old. He is mildly deaf, moderately demented & now he can’t get to the bathroom on his own. A Home health aide comes twice weekly to  bath Grandpa—but it’s not nearly enough help. Grandpa’s dementia is worsening &  he often keeps Grandma up late into the night with his confused ramblings. Grandma has health problems of or her own  is getting worn out! She needs help. Her children call often but live far away and can offer only moral support.

I meet poor, frazzled Grandma at 2AM on a Sunday night when she brings Grandpa to the Emergency Department. On exam he is pleasantly confused, has a wet patch in his groin area, and  has dried food in the corners of his mouth. Grandma is exasperated and  tearfully states “I simply can’t take care of him any longer!”—and” I refuse to take him home!”
 Unfortunately this is a very common scenario in our retirement oriented community. We get at least one such “case of Elder Ditch” per shift!

I do a medical workup on Grandpa & find no new medical problems except slowly worsening dementia. I call the Social worker for help. She & I both agree grandpa needs to be in an assisted living center. Now comes the ‘Catch 22”-Care centers are very expensive (in excess of $300.00 a day) Medicare will pay for up to 6 weeks in a care center BUT ONLY AFTER A 3 DAY HOSPITALIZATION. (medicare could save 3 days hospital charges if they dropped this rule)  Me and the Social worker  search diligently for an admission diagnosis (Medicare will refuse payment, or sue the hospital for fraud if we can’t find a FIXABLE PROBLEM for our diagnosis) the other option is to send Grandpa directly to a care center—private pay (most care centers will want a $1000.00 check from Grandma upon arrival)
The social worker reveals: “Grandma doesn’t have that kind of money”
The Primary Care Physician says: “Grandpa has no infection, no new stroke, no new heart attack etc. An admitting diagnosis of Weakness, Incontinence, or Worsening Dementia won’t fly with Medicare as an admitting diagnosis”.

Bottom line—Grandpa needs a care center & he & grandma have no money for this obvious necessity. Where are the children? Wisconsin, California?

At this point in the scenario I wish my back molar were a cyanide capsule and I could just bite down….

Dr Who?

Tort Reform in America –too little, too late

The shopping cart example: A young mother is in a supermarket when her 2 year old child accidently falls from the shopping cart. The child strikes his head, momentarily looses consciousness, but quickly awakens & cries inconsolably for about 5 minutes. The child soon calms and is acting normal. The Mother appropriately takes him to be examined by a physician.

The European Physician: Carefully examines the child. Sees the bump on the forehead. He notes that the child looks & acts fine in all other aspects. The Physician knows that even in a well appearing child there is still a 1 in 1000 chance the child may have a skull fracture or brain hematoma. The physician is also aware of the evidence that radiation in a CT scan (Standard of care) can be dangerous to children The Physician realizes that he would have to irradiate 999 children to find that one fracture he may miss. He turns to the mother, explains the risks, and reassures her. He gives her a list of signs to watch for. In his country the legal system and the lay population know that the standard of care has been followed. His countryman also realize that because annually several thousand kids fall out of shopping carts and….statistically a fracture/hemorrhage will be missed.

The American Physician: Carefully examines the child. Sees the bump on the forehead. He notes that the child looks & acts fine in all other aspects. The Physician knows that even in a well appearing child there is still a 1 in 1000 chance the child may have a skull fracture or brain hematoma. The physician is also aware of the evidence that radiation in a CT scan (Standard of care) can be dangerous to children; he realizes that he would have to irradiate 999 children to find that one fracture he may miss. He knows however, that American’s demand 100% certainly in all aspects of medical care. If he doesn’t order a costly CT of the child, the mother will be angry or feel that “the doctor didn’t care enough.” She may even write an angry letter to hospital administration. The physician knows that 100% accuracy is expected of him and ANY missed fracture will result in a costly lawsuit. The physician sighs & goes ahead & orders the CT scan of the well child.

It is not just greedy attorneys that are the problem, it is a matter of national perspective & psyche:

The European: see’s fat people and blames it on Junk food & Lack of exercise. The American: blames McDonalds

The European: sees the space shuttle disaster as a tragic accident due to the very technical & inherently dangerous exploration of space.
The American: wants to close NASA down until a completely safe shuttle is available
.

Lightning strikes a man golfing. “Bad luck!” says the European. The American says ”Let’s sue the weatherman & find a way to hold god himself accountable”.

Until Americans “get real” & stop getting their medical knowledge from unrealistic television programs, tort reform won’t change the very broken medical system we now “enjoy”