Is anyone else having difficulty getting in touch with a doctor?

PAs fall under the supervision of a doctor. Find out who that Dr. is and ask that your husband see him. A NP is more educated and in some states they are allowed to be independent. In my state, they have to be under the supervision of a Dr.

Ch, who signed for his discharge?

You can refuse to sign for discharge, citing the fact that he is a danger to himself and others if he is still actively hallucinating.

Me, I'd call 911 again and have him re-admitted.

Our entire medical system needs a redo from the top down. It is just one major mess. As it applies to seniors and their increasing needs, it's just a hodge-podge of bits of information and care that have no link to each other. They really depend on the ER for urgent/emergent situations. In theory, this is fine, in practice it's a disaster because the ERs are overtaxed, overcrowded, and understaffed. Let's not even get into the entire COVID mess. I cannot see how socialized medicine can be worse than the system we are currently working under.

You must feel so weary, and so abandoned.

Just before my LO was diagnosed with dementia, her very competent and attentive physician, who was a nephrologist by specialty but practiced very actively within the geriatric population, had also resigned, but just by luck, LO had almost immediately become attached to a geriatric practice of whom her original physician wholeheartedly approved.

then less than a year later, when she entered assisted living, I requested the doctor on staff there to be her doctor of record, and again, a wonderful match, and again, just sheer luck.

Are you considering another search for a geriatric specialist for your husband? In my state, not too far from yours, it seems to work best when someone has an umbrella oversight of the patient’s care.

My LO also has a rather complicated but so far VERY EFFECTIVE insurance plan, and it seems to support most (perhaps all) of the recommendations that are made for her needs.

If you have confidence in your “home nurse”, would it be worth asking her if she knew of any comprehensive geriatric practices near enough to you where your husband might have a chance to be seen sooner?

Your situation reminds me of some similar episodes while I was taking care of my mother.

My mother didn’t like doctors, and until she had a stroke at 85, simply never went to them. NEVER.

When she needed complex specialized help, there wasn’t any one for us to take her to.

Feel comfortable ranting. There’s ALWAYS somebody here who will listen.

Thank you. I think I will do that.

This is a very sad story and I am so sorry you had to go through all of this. I think doctors and nurses and health care workers in general are suffering from burn-out because of the Covid problem. We lost our hospital in this area and have to travel 15 miles to an Emergency room. There are plenty of Urgent Care clinics in the area but it is expensive to see a doctor there. The Economy is so uneven in our society and I do wish we had more individual care. Socialized Medicine may be a way to solve this problem. We all need health care.

This is a California state specific site that outlines how to challenge a dischatge. Google the name of your state and "how to challenge a hospital discharge".

http://canhr.org/factsheets/resrights_fs/html/fs_challengingdischarge.htm

It is nation wide. The problem is that it is now an industry and the ones with the degree are being run by a bunch of desk jockies and they are sick and tired of the nonsense.

It is only going to get worse.

We actually already have socialized medicine, we just pay personally for the crappy system it has become.

Something is still amiss in re to your husband's behavior. It's pot luck but an ER visit again might get you a compassionate doc who might at least get some answers or refer you to someone...People not doing what we do have no idea the energy and time we spend on this....If it were me, #1 that PA would be out of the picture. It's sad but those who depart the various systems may be pressured by the system to say or do things even they may disagree with (and might be why they are leaving. My parents were seeing a wonderful doc in family medicine EVEN I loved. I don't want to burden him, but we do sporadically keep in touch. Anyhow he gave me several names of colleagues in the same practice for the folks to see. While this guys clinical skills may be great, he is, as a human being alternating between being a "mensch" ---a decent, caring kind of guy, and, I'm sorry to say, VERY sorry to say, an a-hole who thinks women...especially good daughters should carry the load--and mind you he is well aware my mother has dementia and is now receiving hospice care and all of this help they need is provided BY ME, the one who has an aortic dissection. One of the docs our original guy suggested, a female, ultimately moved or was assigned to the other side of town. So in the end when mom went into hospice and this not so helpful guy was still in the picture refused to sign the official referral in spite of my having updated him of significant changes, I figured we would go with mom having the hospice MD. She's the one who imo without justification prescribed an anti psychotic. I called mom's neurologist who was in the competing medical system, and a nurse called me back. Point 1...our MD's are human and can get sick and have time off to recuperate or vacation....Point 2...Nurses can be a fantastic source of information and reassurance. In this case the nurse EDUCATED ME in that BOTH of our systems in this town had visiting MD programs...i.e they ( or sometimes a nurse practitioner or other appropriate person) would come to your HOME to see you. We were very blessed. I immediately called and while I was devastated to learn they did not keep or accept hospice patients usually, the person I spoke with heard our story (or my desperation) and sent a message to someone and they made an exception for which I am immensely grateful. It's very hard not having a long-term relationship established with this new MD, but I felt I could relate/communicate with her. I'm sure you like many of us, learn to read between the lines...and what I saw seemed to be a caring woman who had dedicated her career to geriatrics and family medicine...someone whose heart was in the right place.

Yes drs are more hard to get a hold of - retirements and pandemic issues. Mom just moved back to IL and I could only get her into see the nurse practitioner - she is good and had treated my husband when he needed to see a doc and ours wasn't available, The nurse practitioner was able to get her meds ordered - we were having problems with the Dr she was in AL b/c of pandemic - he was basically worthless - left several messages for him to please refil Rxs - no response - Pharmacy was checking with prev doc who was really a good doc but b/c mom was on lockdown due to pandemic it was over a year since she saw her. Thankfully after a lot of calls to pharmacy talking to my drs practice re mom's appt - the dr who hadn't seen mom took pity on us and got some Rxs ordered until we could see nurse practitioner. Mom also has to see the DR and earliest to get in was Oct 1 - for my doc there is no opening for new patients until April 11 2022 - go figure - the practice only lets them have a certain # of new patients.

My husband has left messages with several of his docs with no call backs - luckily nothing urgent - I keep telling him to use the portal - I seem to get a faster response on that. In fact I need to re-contact one of his docs for a referral.

Good luck and keep on them.

I hear you on this. My father who passed away about 4 months ago was shuffled between specialists depending on what his symptoms were over the nearly 2 years he was sick. He had a nephrologist, a cardiologist, a urologist, an oncologist, a neurologist and possibly others I'm forgetting about now. If one didn't know the answer to something, then he/she would refer us to the other. No one could put the entire puzzle together. His PCP who was fairly young and had little to no geriatric experience that I could tell would simply refer him to a specialist for pretty much everything. No one wants to take responsibility because it could end up in a lawsuit. I honestly don't think it would have made a difference if we were in a pandemic or not. His original PCP who was older and I think took senior care more seriously unfortunately moved cross-country to a different state. I wish the system would recognise how important PCPs who have deep experience with seniors are. Especially given the US's demographics: "The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group's share of the total population will rise from 16 percent to 23 percent." (source: PRB)

We are experiencing the same conditions here in Northwestern Ohio. I was attributing it to our rural status. But, I suspect it has also come out of the changes wrought by changes from the ACA. For years, we have experienced a Cadillac version of health care that was, IMHO, unsustainable. However, waiting months to see a specialist just doesn't seem right.

A Nurse Practictioner is almost as good as a doctor; they have seen a lot and have taken some medical courses, and can prescribe medications. If you can get one, keep him or her. Of course a doctor who oversees everything is ideal. Have you considered a new doctor at a similar practice or HMO? At this point, no one would blame you for starting over, since the PA clearly missed something. And I agree, the system has major problems. That being said, I have a great NP I consider as good as a doc, but this is for a specialty. Start fresh. Ask one of the specialists to recommend a good generalist, try to get a quick appointment, and tell him/her your story. There have to be a few out there willing to help you juggle.

It is not the medical profession but overpopulation. Too many old people and chronic illnesses--the elder population has imploded. Not just old--YOUNG people are routinely obese with diabetes as this is a fast-food nation and these people routinely abuse their bodies smoking pot causing lung damage, and abusing narcotics.

Another problem is hospitalization itself--especially for patients with dementia, they can become delirious and they never recover from that. On the other hand, if the infection became RESISTANT to the antibiotics OR caught a hospital-acquired infection on top of his existing one he probably will need to be hospitalized again. With COVID running rampant he is in a terrible situation.

Oral medications are not enough when it comes to sepsis or blood infection. Antibiotics has its own risks including c-diff diarrhea and can impact the heart conduction system.

Behavior changes and hallucinations are not normal--he probably needs to go back to the emergency room. They need to reculture his blood, wound, urine and do follow up x-rays. and do fresh labs to see his kidney and liver status as well. If he has kidney or liver issues that too can cause behavior changes. EVERYTHING needs to be looked at in my opinion only. Who knows what is going on...he may even be dehydrated. But if he has underlying enlarged heart you have to be careful with fluids. Yes it is a mess you have to deal with.

sorry for the run-around, but with this virus thing most doctors wanted to do a zoom session which I WOULD NOT do only because I didn't know how and figured IF I am paying to see a doctor, I want to see him. I can wear a mask with no problem at all medical offices. Plus one doctor actually told me I could end up paying more with the zoom sessions. I personally have a CRNP because our office is all that they have. they are good and have to go to the same amount of years practice, but not sure what else the MD has to have. IF you don't like the one you went to, find another. And yes.......appts are hard to get into, even without the virus stuff happening. IF another situation happens like that again with hubby.....take to the ER. You might have to check to find another doctor in your area, ask around of others who they like/dislike. wishing you luck and hope hubby is getting better.

When one gets sick, it seems that one has to become an "expert" on both the disease, and on navigating the medical care system, almost literally overnight.

Some years ago, my uncle, living in a rural area of central Pennsylvania, suffered a stroke. He needed to have physical therapy, but because of the convoluted system, there was some sort of "window" during which it had to be scheduled, but because he never received any definitive information on this, the opportunity was missed, and he spent the rest of his life in a wheelchair, mostly paralyzed on one side.

A few days ago, I saw an article rating medical care in 11 western countries, and unfortunately for many of us here, the US was #11.

The medical establishment (not all doctors) are pushing more and more actions that mean less and less care. They are falling into the technology and "almost" service trap that all other professions seem to be falling into.
NO ONE should do a zoom doctors appointment. They cannot palpate a wound, check blood pressure, hear a lung fill up with air, nor smell the patient. all of which are needed for a diagnosis.
And while I've had to use PAs before, I found that they are basically useless and nowhere near "almost a doctor". The Nurses have been far more intelligent and listening to the symptoms actually helped with diagnosis and information of which doctor to see (outside the PAs hearing)

Yes, the medical world is changing, doctors are retiring, getting appointments is harder, and everyone is a specialist now. But good doctors are still around, you just have to search hard. Don't give up! Research online. Ask everyone you know who they can refer you to that they like. Ask the home care nurse for a referral. Call the head nurse at the last hospital he was in and ask for referrals for a good primary care doctor. I can assure you the nurses know best. Once you have a good primary in place, everything else will fall into place.

American healthcare is a sick joke. That we're #11 is a surprisingly high ranking.

I'm a member of a menopause support group and lately we've been talking about medical tourism to Mexico including visiting the dentist. And I am NOT kidding! At least in Mexico there still is a physician medical ethos and prices are reasonable.

Also, my best friend's dad is a retired board certified internal medicine physician from New York City. He now lives in Florida and is scared to death of getting sick and being hospitalized and this was pre-pandemic. Toward the end of his career - and he practiced until he was 70 something - he hated being a physician.

He told me that after he affiliated with the big hospital system in his area, the hospital's bean counters told him how to run his practice, how extra inundated he became by paperwork from insurance companies and the hospital's compliance team, they took away two of his nurses and tried to force him to accept a PA, etc etc etc. He wanted to stop accepting new patients because he felt he didn't have enough time to see his existing patients let alone take on new ones. He was overruled and his patient load increased. A scheduler was hired to schedule patients into 8-minute slots, spy on him, and track his "productivity".

When hospitalized, his patients were taken over by the hospitalists, who frequently messed up their medications because they didn't bother to call him even though his patients asked them to call him because he was their PCP.

America's healthcare system isn't healthy nor caring nor a system. Walter Cronkite said that. It started getting bad in the 1980s, has only gotten worse since, and it's going off the cliff.

And cetude I agree with you except for "...It is not the medical profession but overpopulation..." It's both! Like many people, doctors were too timid to stand up for themselves. Now they're getting a taste of what other people who've been outsourced or downsized have been experiencing for decades.

I share your frustration. The medical non-system in this country has been getting worse for decades and it looks like covid is about to finish it off. As we face more and more urgent needs for care-givers and medical professionals, overwork is causing many to quit the profession. Urgent care clinics often send people to the ER without really even trying to help. Just yesterday my husband was told to go to the ER after waiting an hour and a half past his appointment time. The clinic he went to did not spend 5 minutes looking at him, took no x-rays for a potential broken foot, provided no doctor. They will, of course, bill for a normal visit as though a doctor actually saw him and provided a diagnosis. We did not go to the ER. There are waiting times of more than 12 hours there and he simply was not up to it. Never mind the fact that the ER waiting room is overcrowded and includes people with covid waiting for beds to open up. He is at home with his swollen foot propped up on a pillow because no medical attention is available to him.

I find the PA's and nurse practitioners poorly trained and with limited knowledge. They do not have what it takes to make an informed diagnosis. They are no substitutes for doctors. They make guesses, but simply do not have the education to make a real diagnosis in ER or broad intake situations. They have sketchy knowledge about the most usual presentations of the most common illnesses but absolutely no clue about unusual presentations or even slightly rare conditions. I am not faulting the individuals who do these jobs; they are expected to do the job of a doctor with 4 years of medical school and several years of internship and residency requirements but may only have a 2 year certificate with considerably less rigorous requirements. There simply is no comparison between a PA and a real doctor.

It is time to get rid of the medicine-for-profit model. It has failed us utterly. Perhaps it is also time to fully fund medical school for qualified candidates and increase the number of fully qualified doctors to a number equal to that required. In the last year I have seen the number of doctors and RNs in our local hospitals and clinics decrease as the for-profit institutions lay them off and bring in cheaper PAs and cna's to do the work more cheaply. Then they raise the price they charge us to keep up the profits while we are deprived decent care.

Can u take him to the er or emergent care, and say he just started hallucinating and you thinks it's a uti.
A person isn't supposed to have a uti for weeks or months without being treated. Thats rediculious!
In the mean time you need to find a geriatric primary doctor.
I would get him there asap. Don't say you have been to other docs and they did nothing. Don't mention anyone or anything. If they ask about his last doc, she retired abruptly. That's all you know. Don't offer anything about his appts, or the PA not diagnosing properly etc. Nothing. Get him there Pronto. Good luck.

I too am in Maryland and yes, this has been going on for about 10 years I think. IMO, there isn't the return on investment for people to be doctors anymore, with the high cost of medical school and malpractice insurance. My OB/GYN office went from being a private practice (who sold their business ) to a sort of free clinic about 8 years ago, so I stopped going there and found a doctor that is only a gynecologist who practices alone. Less malpractice insurance when you don't deliver babies. Anyway, around the same time I noticed the shift was beginning with other doctors, towards there being only one doctor per practice who then has PAs or NPs that work under him and unless you were already seeing the doctor, you can never get an appt. with him or her. NPs have their own practices around my town and they are fine unless you need more specialized care. Also, most of the docs no longer have hospital privileges, so you are only seen by a hospitalist if, god help you, you have to go to the hospital. Your doctor who knows you can't treat you there. It's awful.

If you feel unsafe and he is hallucinating, I would take him right back to the ER. They should admit him until he is stabilized. I am sorry you are going through this!

Sorry that you are experiencing this stress. Behavior changes and hallucinations do point to something being a problem. All nurse practitioners and physician assistants are overseen by a medical doctor. Insist on seeing the doctor since your husband is having complicated issues. This is not only your desire but also your right.

If they can not give you the appointment, it may be time to shop for a new doctor. I would urge you to find a doctor that specializes in internal medicine rather than family medicine. If you can get one that specializes in geriatrics, that would be best. Look for a group practice that has several medical doctors and less NPs or PAs, since that is your preference and you have more opportunities seeing a medical doctor for any problem.

As for the current situation, I expect the hospital set your husband up with several specialist appointments because he has multiple problems that need to be addressed. Orthopedics or podiatry for foot. Maybe cardiovascular for the foot as well. Neurology for the hallucinations and behavior changes.

If you feel unsafe with your husband at any time, take him to the ER or call 911. You and he should be cared for in ways that keep both of you healthy and safe.

I had a life threatening situation a while back - freak accident - leg crushed and I could see the bone. I was delirious with pain and assisted living did NOTHING......HORRIBLE. Finally I found the inner strength and ability to call the doctor (I couldn't because I was so out of it in the beginning). They refused to make an emergency appointment, etc. I blew up and threatened to sue the entire practice and them personally if I did not get in at once. Still had problems with them but I got to the office and same crap - could not be seen. I went ballistic to the point the doctor left his examination room with his patient and came out to see what was going on. I told him and showed him my leg. He was furious and said this was a true emergency and I could die and I was entering the hospital immediately - I spent a week fighting for my life. My advice is to threaten - and be prepared to follow through with whatever means you have available - sometimes there is no other way. My blowing up and threatening is what actually saved my life.

I live in Maryland too and have had some similar problems in the past. This is the trend in medicine in the U.S.

Once when I had my mom in a respected hospital ICU, I was told by her surgeon that I better get mom home (he discharged her from ICU to home - warning that the night nurses there were very difficult - he even said that he thought if mom stayed in the ICU that night he feared she wouldn’t make it through the night.

Don’t settle for anyone who is not an MD.

If you live in the DC area send me a private message - I could recommend a practice where we have received excellent care.

if he is on a few different medications, chart them out to see if they could be causing confusion. That happened to us.

Look for side effects and warnings of negative interactions. The pharmacy print outs will be a good place to start.

You can’t take him off meds without a doctors supervision - some must be tapered.

Imho, I live in Maryland, too, and only partially experience the issues that you're dealing with. You need to advocate for your husband. I advocate for myself to the specialist or the medical professional if they are unwilling to address my health issue. Recently I went to the ER for a near syncope episode. They were going to send me home at 1 o'clock in the morning and as I still wasn't feeling well, I advocated to have an overnight stay and the Hospitalist okayed it. It did not make sense to send me home at such an hour, feeling like I was going to lose consciousness (syncope) AND then have to return to the ER posthaste.

Yes.
Google is my diagnostic then I call the appropriate physician, and make an appointment.
I had an issue with an ENT’s medical assistant.
She acted like a “barium swallow”needed approval and it doesn’t.
The ENT heard her scaring me, that it “might not get approved,” and he hollered at her from his office. (The door was open)
She did nothing for 8 days!
I called United Healthcare crying and they put me on hold and called the office, twice. Nobody picked up so they left (2) voicemails on my behalf.
I didn’t know they did that.

That vindictive medical assistant, “ghosted” me out of spite, delaying my dysphasia condition.
UHC called back 2 days later and they filed a complaint against the “staff.” They were VERY angry.
Why would someone be so reckless and nasty to a choking (literally) person?
My “primary” got involved when nobody would answer the phone.
What a nightmare over a test.
I finally got it 2 days after all those calls.

I find Walk in clinics to be very thorough, available and attentive.

Find comfort knowing it’s not just happening to you.
Hugs to all struggling to get an appointment. 🤗
Be vigilant and verbalize your distress. 🗣 🚨

I feel like four of my husband's doctors have basically dropped him. After he refused heart surgery, I was unable to make any more appointments with the cardiologist. His rheumatologist and neurologist have refilled prescriptions without requiring an appointment. And his oncologist has not offered a follow-up appointment (although dh doesn't feel he needs it any way, no cancer, just a 1% chance increasing by 1% each year of developing the cancer his brother had).

My husband is a fourth generation family practice physician. He retired recently at the age of 77-1/2 years old. Doctors today don't want to work that hard or that long. His own children who are subspecialists are now retired. I read your comments to my husband and he had tears in his eyes by the time I was finished. I hope you will continue to seek a good family practice physician -- not a PA or a NP or ARNP. I suggest you contact a local hospital with family practice/family medicine residency program and/or geriatric fellowship program. They can help you with being able to have your doctor seen under their service or direct you to a good physician for your father. You may have noted that everyone in the medical field from doctors to medical techs, pharmacists, PAs, Nurses, Nurse Practitioners, etc. as being referred to as "Providers". There is a difference between each of these. Seek out the ones with the most education/experience and qualifications. You pay the same for the less trained, less experienced and less qualified. I wish you well. If you can let me know what area you live I may be able to point you in the right direction.