How to get doctors, visiting nurses and facilities to work together to not have so many appointments? I fear I am going to lose my job!

All my doctors -- and my parents-- doctors have an online patient portal where results are posted with secure ID/PW logins. My father is 84 and knows how to login! Doctors even post comments if needed, patients can ask questions too. Perhaps find a more progressive practice?

I was hoping their price had come down. I heard that Pradaxa had a high copay. I have a very poor friend who takes Eliquis. He probably receives some extra assistance to help pay for it since he has lived for years on a small disability check.

Another consideration is why not try another blood thinner that does not require the testing. Would Pradaxa or Eliquis not be good?

INR=International Normalized Ratio

Snewman: Is your mom able to relay the INR # to you or her doctor? That's all they're looking for so they can adjust the Coumadin dose. Then the new med, if needed, could mailed to her.

The overarching question here is "how much medical oversight does your parent need?". When your parent is at the point that they need more oversight than any one person can provide, it's an indication that they need a higher level of care.

My mom, living "independently" needed to be seen by PCP, Cardiology, Neurology, ophthalmology, etc. We consolidated. Mom went to Independent Living, where geriatrician managed all but the psych meds. On site geriatric psychiatrist managed those.

You may not need a visiting nurse. If u find this true, then tell him they r not needed anymore. If the clinic doesn't except VN draw, stop the VN from drawing.

What doctor does the VN send their info to. These facilities work off of orders from a doctor. Meaning he has to give the order for blood draw. That draw goes to a lab and doctor gets results. When u mean clinic, is that where her primary is? Did the VN tell you that u needto keep them informed about doctor appts? They cannot bill Medicare if ur Mother goes to another doctor the same day of their visit. You may not need a VN if what they do is being taken care of somewhere else. Check her Medicare and supplimental statements. Something may not be being paid because tests are being duplicated. Is ur Mom in an AL or nursing home? Facilities have nurses on staff that can check vitals. You may want to make an appt with Moms primary. Explain what is going on. I agree, results can be given by phone. Appts are just ways for doctors to bill Medicare. When I took over Moms bill paying I found she was going to her primary every 2 months. I asked why, answer was "he wants me to come back". When I took her the first time he asked why she was there. You told her! One of the nurses was a friend and said there really wasn't a reason for the every two months. Ask questions, why does she need to come back. Medicine changes can be made by phone. If ur Mom is on Medicaid, I think someone is taking advantage.

Is the blood check for Coumadin? Get the Visiting Nurse Association involved.

I forgot to add that we also had an aid through home health that came three times a week and that the RN and LVNs came as often during the week and weekend as we needed. If her weight went up or she needed a urinalysis etc. We didn't abuse the system but we certainly used it.

I took my mother three hours away to some of the best medical care in the world. She saw all her drs on the same day.
Pacemaker check. Internal meds. Cardiologist and when needed urologist and orthopedic surgeon. They were all in the same bldg. except primary but all associated with the same hospital and all had access to her medical records electronically. The cardiologist was my dads dr and we made an appointment with him to have my mothers heart checked out at 90. That led to the pacemaker. We utilized home health care that we chose based on reputation and had the dr write the order for. She saw all these drs once a year. All I did was start with the cardiologist appt and tell the others the day I needed. In the beginning the cardiologist ordered us the INR testing device so that my mother would have it when she visited with her granddaughter but the granddaughter wasn't comfortable with taking the readings so we just got a dr and home health in that location the couple of times she went for a long visit. Otherwise home health came once a week and took her vitals and filled her pill box. All her blood work including her INR was done at home and results were faxed to her drs. Adjustments were made as necessary to potassium, Lasix, Coumadin. My mother recorded her weight everyday. She had OT and PT ongoing over the years. When the CHF got out of bounds we would take her to the ER with the hospital all our drs were associated with. This resulted in admission where she would get the excess fluids removed and any other issues going on treated. This probably happened three times in eight years. When the CHF began to be harder to manage we added the Heart Transplant and CHF clinic associated with the hospital. This made it easier to get more advice on managing her episodes as they occurred. She also had a fractured spine ordeal where we traveled to the ER, did rehab and had a CHF episode. She preferred getting better medical care regardless of the long drive. The drs appreciated the long trip was hard and were willing to work with us. We did use the local ER a couple of times to get a Lasix shot when the fluid got too much but we were always holding our breath that we would have a hard time keeping the local ER from wanting to admit her in the local hospital which we viewed as a fate worse than death. Pretty much our rule was don't go to an ER where you wouldn't want to be in the attached hospital. After a couple of these local visits we started using the heart failure clinic and it was so worth it.

Could you get a meter to check blood clotting factor and just call in the numbers? Also go to a lab that posts results on line, you can check them yourself.

My thought on this is if it isn't a major health issue, people don't keep needing all these follow-up appointments. My gosh, I use to cringe when I heard the scheduling clerk say the doctor wants to see your parent in 6 weeks.... my mind is thinking how am I going to get yet another morning or afternoon off from work :P And there is more doctors to see with the same requests.

That is why I had really liked my parents primary doctor, as she was looking out for the grown child who was running up and down the highways with the parent(s) and sitting in waiting rooms, thus everything needed that doctor got done while we were there.

Guess I could use a few rainbows, Cwillie.
I won't really cut my nose off to spite my face, so I will try to go to physical therapy for me.
Who woulda, coulda thunk that we could go to the same place, together as recommended by P.T. Not happening.

Some doctors seem to be clueless, some are just addicted to the fees they collect by scheduling all those little unnecessary appointments. (No need to wonder healthcare costs are sky high)
Sendme, maybe if you were a unicorn you would fart rainbows too ;)
but alas you are only a woman and can only do so much!

We had this discussion just this morning. I started physical therapy one week, and by the end of the same week, husband with cognitive issues requiring help went and made so many conflicting appointments with his own schedule that physical therapy and chiropractic were scheduled the same day-which medicare won't approve. After intervention, including covering an unmet $150 deductible from the budget, ouch, just to get him care, I am ready to cancel ALL my own PT appointments because I really just cannot do this, or be run down by this.
He refused to reschedule, off he goes.
A fully autonmous adult with supervisory needs and needing a rep-payee.
Today, I am just giving up.
Just venting. Because I am sure if I was a better person, tried harder, he could have all his needs met. No advice needed here.

exactly what I'm saying....this is how it was done when she lived in Alabama...will have to present this to the Doctor this Saturday...

Her Primary Doctor wrote up the order for the visiting Nurse so with that I thought that what ever he orders for the Nurse to do would suffice....also..the coumadin clinic is in the same building!...

Yes...we ran into a similar situation with her potassium level...her Primary Doctor and the Cardiologist he referred her to had her doing 2 different dosages...well she ended up in the hospital with low potassium and then 2 weeks later back to the ER with high levels...making my own head spin while writing this!!...

Yes...her Doctors are in the same network so to speak and that is why I am so frustrated!...I have to wonder why they have visiting nurses if what they do is not trusted by the facilities?

You're living in a different are up around Clare, probably not as well developed coordination as there might be in a metropolitan area where there are numerous hospitals competing with each other, and an abundance of doctors.

When we had PCPs, I told them I would ask the specialists to send them letters on visits. There's no need for a PCP to overlap a specialist such as a cardiologist. One PCP kept wanting to try a different cardiac med than that prescribed by the cardio who had been treating for over a decade. I told him no; that's a specialty area of medicine and the decisions stay with the cardiologist.

She never came across this issue while in Alabama...everyone worked together...I agree with the serious appointments being necessary but I thought that perhaps because she is new to them may have been the issue at first but now it feels excessive...she went to a Heart Failure Specialist just last week and they found everything to be fine!...she has an appointment this Saturday with her Primary Doctor so this will be the time to set some new rules....thank you so much for the input!...:)

Just reading the comments that were posted while I was writing, you really do have to put your foot down and decrease the number of medical appointments or you'll both be ready for hospitalization just for R & R! Stand your ground, be firm. Doctors don't coordinate appointments with each other and have no way of knowing that they're overburdening you.

You can also ask at each appointment what would be required to happen that you need to return - i.e., it's a delicate way of asking what's REALLY necessary, not what they want.

I wouldn't refuse follow-up visits, but there are obviously too many of them taking place.

You might also try to select doctors that all have privileges at the same hospital. Check Mt. Pleasant and Midland, even though neither are quite close. In our area, hospitals and doctors are connected electronically so they can all access a patient's records through the hospital network. It greatly enhances communication.

You're discovering the same issue I discovered. Our Coumadin Clinic would not accept blood draws from anyone other than those pharmacists on staff who did the draws.

It's understandable; there's a liability issue. The clinic has absolutely no way of verifying that the blood sample is from the patient - nor any way of veryifying the competency or accuracy of the nurse who drew it. So the clinic would be putting itself in the situation of prescribing Coumadin dosages to someone it had not seen or from whom it had not drawn blood. It's a potentially dangerous liability issue.

I also would query why your mother would need to go to the doctor's office when the pharmacists are more than capable of addressing the results, prescribing alternate levels, advising of potential interactions, etc.

Our cardiologist turned the entire practice of blood draw and management over to the Anti-Coagulation Clinic, and they were more than well qualified to handle all issues that arose.

I would raise this at her blood draw this week.

In the past visiting nurses have asked to perform blood draws and I explained to them it's not feasible, and that we would continue with the Anti-Coagulation Clinic. They understood; they were just trying to be helpful.

I once drew the line at no more than 2 medical visits per week; then dropped it to no more than one. Now we don't go for medical visits during harsh winters unless it's an emergency or a follow-up appoint on something really serious, such as vision status. Enough is enough.

It may be time to switch to a healthcare group that doesn't require so much from a caregiver. It sounds like you are working for their convenience. Some doctors are like that. Having to go to the doctor that often seems unnecessary to me. My mother's clinic puts her lab results on the computer, so we can check in to see them. Her doctor will also send messages or call, instead of requiring her to come in. Saves time and money that way.

YES!!!!

Thank you...that is where I am at after today...My Mother is in complete agreement with this as well...she moved back to MI from Alabama in October and as of this week she has been to appointments in upwards of 30 times...I have told them specific days and times but still feel they are having her come in for stuff that could be told over the phone...is it right to tell them that the visits are excessive?

The visiting nurse we had would call the primary MD. He was the one who would order any additional tests, or order the nurse to give vitamin K if there was a danger of hemorrhage. Can you arrange that?

One thing you can do is assert yourself a little more. When they call with an appointment for Thursday at 1:15 tell them "no, that won't work, I am only available xxx". Decide what your healthcare goals are and whether or not all these appointments are really needed, there is no point going in for a colonoscopy for example if you would never consider doing chemo or surgery to treat it. Have your mother fill out the forms necessary (HIPPA) so that you have the authority to liaise directly with the doctors without your mom being there, and make it clear that you won't be attending frivolous appointments.

Thank you...She lives at home...the visiting nurse comes to the house twice a week and in today's visit the nurse checked her coumadin level and apparently the coumadin clinic does not work with the visiting nurse...now she has to go in to the clinic to have same test performed later this week...that is the frustration......seems like every test that is done she has to go in to the Office for the results...I myself have lupus and related issues and don't require this many visits...totally baffled!