The Hospital Should Not be the Default Suggestion….

Readers of this blog know that much of my inspiration – not to mention my first-hand knowledge of health care for seniors – comes from my soon-to-be-91-year-old mother. Over the course of the last year, her kidney function declined to the point that she requires dialysis, to which she has responded beautifully. She continues to get “high marks” on its effectiveness for her, and she has more energy than she has had in several years.

Despite some physical maladies, my mother is as sharp as ever, and is able to serve as her own best advocate.  This came in handy over the past month or so, when she was experiencing some shortness of breath. Her cardiologist suggested that it was all in her mind, but the PA in her nephrologist’s office wanted to send her to the hospital.  Since it was not an acute situation, my mother decided, instead, to wait until her next dialysis session. She shared her concerns with the nurse, who realized that they should be drawing more fluid.   Since she had only about one day’s worth of relief, she mentioned it again, and they drew a little more the next time.  It has now been a week, and she feels great.

How much cost would have been incurred by Medicare, my mother’s supplemental insurance and the system in general if my mother had followed the advice of her nephrologist’s office?  How many unnecessary tests would have been run, and how much more would it have cost to drain some fluid, which is done routinely during her dialysis?  Yet the hospital was the default suggestion of this doctor’s office because it is apparently easier than reviewing my mother’s chart or involving more staff than the PA who takes incoming calls?   This does not even include the “cost” to my mother of undergoing the stress (and increased risk of infection) of an unnecessary trip to the Emergency Room or admission to the hospital.  While the hospital certainly has a role to play in the healthcare system, what can we do to assure that it is not the first option for non-acute situations, where it might truly do more harm -both personally and to  society – than good?



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