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Question for any Richmond Docs...(any any really)

Discussion in 'Other Off Topic Forum' started by mambodave, Jul 20, 2008.

  1. mambodave

    mambodave Formula Junior

    Jun 3, 2005
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    Future grandfather in law is in a hospital in Richmond VA.

    Long story short.. Had had no nourishment for 8 days now. On Call doc refused to come in to ok and supervise the feeding tube... This hospital is VERY slow and he (doc) said he may come in tomorrow, which means he wont get "food" untill tueday.

    How the hell can we get the feedinng tube in today? Can no one at this hospital overide it? We spoke with the nursing supervisor and she said the onoly thing to do was to speak to administation Monday....

    This is complete BS. He is awake, and asking for food, but cant swallow.....

    Dave
     
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  3. GatorFL

    GatorFL Moderator
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    Lawyer up now, sounds like classic malpractice. Better to have assistance now, than later if he should unfortunately pass. I wish him luck, doesn't sound like a great situation or hospital.
     
  4. DrStranglove

    DrStranglove FChat Assassin
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    Yep.

    Dave, get the lawyer, almost any lawyer in a pinch, and have him call the hospital admin RIGHT FRAKING NOW. Get an exp for why he is not fed in one syllable words if you have to.
     
  5. Sfumato

    Sfumato F1 Veteran
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    Get name of MD. Immediate family should report them to state medical board, often online. If in group of MD's, get another MD in group contacted. Contact medical staff chairman, should be a staff MD(NOT hospital administration) immediately. All hospitals have administrators on call 24/7/365, so ask for on call or in house supervisor.

    Is it a real hospital, or a nursing home? Does he have some advanced directive about no feeding tubes? That can be issue too, you may not be aware since new to family.

    Delay of care/refusal to speak with families are amongst the top reasons MD's get sued. Duh. Sorry you have this problem. Even if he gets the tube, the family should report this to med board. Not enough doc/nurse/attorneys get reported to their respective boards/bar, so problems recur.
     
  6. vvvmd

    vvvmd F1 Rookie
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    Getting a lawyer now is not the answer. All this will do is complicate his care, avery one will be defensive and you will be seen as hostile.
    1. Call the attending doc and find out why your future in law can't swallow. If he has had a stroke then the swollowng mech. may not work and a simple nasal tube may be all he needs. Nurses can put these in. If it is a mechanical problem from a cancer or a stricture then a surgical tube is needed. Hard to get those in over the weekend.
    2. If the doctor doesn't respond then call administration.
    3. If administration doesn't respond then get him transfered to another hospital. It is your right to do so.

    It's frutrating but do not lawyer up will only make you seem hostile and may hurt more than it helps. Get a lawyer if he gets a complications from not being fed.
    As long as he has an IV going without food for a week realy isn't a big deal. When I was a resident we would start all our surgical patients on IV hyperalimentation the day of surgery. Did more harm than good. I deal wioth a lot of G tubes. PM me if I can help you out.
     
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  8. GatorFL

    GatorFL Moderator
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    Sounds like great advice.

    I see the other poster advised against getting a lawyer involved, I strongly disagree. Lawyering up will get their attention and (hopefully) get him the care he needs. Not being fed for 8 days despite asking for food is reason enough to have an intermediary deal with the administrator/staff chairman. Waiting until complications arise is too late.
     
  9. vvvmd

    vvvmd F1 Rookie
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    Getting a lawyer at this stage of the game will get yo labled as a HOSTILE patient or family. You won't get any better care, you may get stuff done that didn't need to be done and it will cost you money. You get more flies with honey than with vinegar. Reporting to the medical boarrd etc is reasonable if you don't get results. Work with your doctor and the hospital administration. There are many legit reasons the tube didn't go in during the weekened. A simple feeding tube can be placed by a nurse. If there are anatomic reasons your future in law has thats keeping him from swallowing then a weekened with short staff is not the time to be doing an invassive proceedure that has risks and may lead to complications. If you need expertice to place the tube better to wait and get it done with a full staff rather than push it and get inot trouble. The way to solve this is to talk with your doctor, and administrator. If they don't help then transfer to another hospital then call the medical board and lawyer. If you want the doctors, and nurses taking care of your loved one to think you are a PR*CK when they are still taking care of you go ahead and call a lawyer. You may get what you want but it may not be whats needed.
     
  10. vvvmd

    vvvmd F1 Rookie
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    8 days of staravtion as long as hydration is maintained is not a big deal. I perform lots of surgery where the intestines stop working for several days. You can't use the GI track for nutrition in that situation. When I was training we would routinely use IV hyperalimentation to keep people from starving. It mad things worse, lots of infections, lots of electrlyte abnormalities, elevated blood sugar etc etc etc. You now wait 8 to 10 days before you start artificial feeds.
    Not eating is an emotional thing. Iv'e had people that had nonfuntioning GI tracks sneak off and get food. They would then puke their guts out. A little lated they would do it again. They shouldn't be eating because there is something wrong with their intestines but the want to eat any way. Just because someone in the hospital wants something to eat doesn't mean they should be eating. TALK TO YOUR DOCTOR to solve the problem.
     
  11. slm

    slm F1 Rookie
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    Yes it will, but usually not in a good or productive way. My response is usually "obviously we are not able to provide the care you feel your loved one needs. You may want to consider alternatives."

    I have to agree with vvvmd. Everone knows that nutrition is important and placing a feeding tube and starting feeds can have consequences. Very difficult to say based on very limited information.
     
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  13. Bluehinder

    Bluehinder Formula Junior

    Aug 9, 2005
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    Getting a lawyer is the worst thing to do. Contact the hospitals Chief of Staff, who is the president of the medical staff, and whos job is taking care of problems that fall in the cracks. I say this as a past Chief. He will call in the doc, and make a transfer to another doc if the original is not helpful. He knows all about lawyers, and his job is to prevent one from coming in.

    I'm also sure there is more to this story.
     
  14. TexasF355F1

    TexasF355F1 Four Time F1 World Champ
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    I'm sorry to hear this. Hopefully things will work out.

    Suing hospitals for malpractice is probably of the most difficult cases for anyone to win. We attemtped to sue for negligance and causing my grandma's massive stroke after surgery back in '94. Didn't get anywhere and just dropped it because it would have cost more money than we would have seen. And then there's the emotional aspect.

    I don't see how so many "medical professinals" fail to actually help. Are their ego's that big?
     
  15. vvvmd

    vvvmd F1 Rookie
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    We don't know the full story behind this. All we know is that on a Sunday the on call doc refused to supervise placing a feeding tube. There are multiple medical reasons for not putting in a feeding tube. Maybe the doctor on call had another case that was critical maybe the doctor didn't know how to place a feeding tube. Maybe a feeding tube is contra-indicated in this case. Without knowing the whole story you don't know why this is happening.
     
  16. Sfumato

    Sfumato F1 Veteran
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    2-3 days before hyperal usually started in my experience. Wasting and deconditioning starts early. Infections/lyte imbalances/hyperglycemia from TPN (total parenteral nutrition for youse guys)? Then it isn't being done correctly. Properly done, labs should be normal, and infections come from poor technique/nursing. Long term TPN can blow a liver, but that takes months and you see liver labs climb then drop.

    Don't lawyer up unless no response. If stonewalled, get him the he11 out of there to another facility, have it documented it was insufficient care, and call insurance co. so not stuck with bill to move. Discuss same with hosp. administration.

    IT IS DOCTOR'S OBLIGATION TO TALK WITH PATIENT AND FAMILY. Not doing so is piss poor medicine, and begging to get sued. We both have had emergencies, and I don't know about you, but I'm not done until I'm done. An issue was there, he needed to fix it, or speak with family. Sucks, but that's call. Been doing solo call for 7 years, and I think this was inappropriate, as was nursing supervisor response.

    I've cleaned up after messes like this, and the families are even pissed at people trying to help them then. Anymore, doctors are assh0les even to their colleagues. No excuse for doing that to patient or family. Deserves whatever he gets.
     
  17. DennisForza

    DennisForza Formula 3

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    X11billion
     
  18. DrStranglove

    DrStranglove FChat Assassin
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    I thought that was his complaint....
     
  19. Sfumato

    Sfumato F1 Veteran
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    It seems they couldn't get to anyone who could give response, as administrator on site shrugged, and MD blew off talking to family. Not point to lawyer up.

    No we don't know situation, but OP did not mention MD spoke with family, just said they'd take care of it tomorrow. Monday they're off call, so it got turfed. Unanswered questions get families upset and suspicious. The doc he was covering for has a nice Monday AM surprise waiting. Any of us docs been screwed like that before? Clinic running 2h late to undo someone elses F/U? Please.
     
  20. J. Salmon

    J. Salmon F1 Rookie
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    Sorry to hear about this Dave. I went to medical school in Richmond. There are mostly good hospitals there, but there is some variation.

    Definitely need to talk to the doctor in charge. You are doing the right thing - stay involved. I know it seems frustrating, but it is true that no one can really understand his care from a few lines on the internet. Many, many variables. I am also one who would say that contacting a lawyer now is not the way to go, as lawyers are not good at treating patients Getting the best care for him is the point, right?

    Talk to the attending physician, explain your concerns, and get answers. If you do not agree, ask for a second opinion. Contacting a hospital administrator could be helpful to expedite things.

    Hope things turn around quickly for him. -J.
     
  21. vvvmd

    vvvmd F1 Rookie
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    Very angry response given your kind word is better than a loaded gun signature.
    I two tqke solo call and I'm not done till it's done but we don't know the whole story. And yes done perfectly TPN is helpfull but still risky.
    I've been in practice for 20 years noww. The trend is to limit TPN in surgical patients in the immediate post op period.. Stress hormanes right after surgery limit TPNs usefullness and only makes for expenssive urine.
     
  22. Sfumato

    Sfumato F1 Veteran
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    Not angry, impatient and tired of cleaning up messes or being hung out to dry by lazy MD's. GI won't take care of a post-op Liver tx. Hospitalist doesn't want to take care of an asthmatic with periorbital cellulitis-"it's a pulmonary patient". Anemic patient has o2 requirement, so it is lung problems despite normal CXR and exam. Consultants in other specialties telling family that attending and other specialists don't know what they're doing (same GI that won't care for post-op liver, I've done lots of transplant med, so I can do it, but why?).

    OP didn't mention surgery, agree who knows. BUT, response to family concerns by hospital and covering MD was inappropriate. Talk to your patient and families. May take 2-3 minutes on phone, or 1-2 hours next day by another. Been on both sides of knife too. Not any better when you're in the biz.

    Get's old when billing and convenience come before care, but that's how it is. BTW, I had MRSA empyema surgeon wouldn't do. Worried about BP fistulae, and teaching me about parenchymal vs. pleural disease. 14 days of 105 fever on 4 abx with ID and I saying she needed VATS. I said FU and had CT surgeon do her. Necrotic lung removed, rind and pus drained, went home on IV abx post-op day 6. And I should be happy why?

    BTW, been doing this 19 years, solo call for 7. I read literature in and outside my specialty, have to. It is behavior of an MD here that is problem regardless of medical details.
     
  23. italiafan

    italiafan F1 World Champ

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    #20 italiafan, Jul 21, 2008
    Last edited: Jul 21, 2008
    "Making long stories short" on medical issues, on the internet?
    Do you really honestly believe that is an intelligent way to go about getting good advice regarding healthcare for a loved one?
    I don't know which is more pathetic, your post or the people who felt the need to jump in with Doctor-bashing posts when they obviosuly have as little information on the specifics of your loved one's case as I do right now.
    Consider:
    8 days of starvation becomes overnight medical emergency for an on-call doc not directly related to care of patient? Doubtful.
    What time was the call? 8am or 11pm?
    Why not have RN place NG-Tube that minute? Perhaps one was already in place?
    Was he getting hyper-al/TPN, and thus some form of nutrition?
    Can he consent for a procedure? Was family present?
    Does he want a surgically-placed feeding tube?
    Maybe on Friday he was doing a little better and the hope was he wouldn't need one, and then he clinically declined over the weekend. If receiving IV fluids then appropriate to await his regular attending, who knows his case best to discuss long-term options including procedures.
    Maybe his doctor discussed all of these issues with him, and you in NC have no clue about any of those discussions. Furthermore, maybe he has discussed this as well with patient's healthcare proxy and doesn't have any desire or need (morally, ethically, or legally) to discuss them with you.

    In short you either know nothing about his case, or decide not to post any real information.
    All other discussion is harmful as evidenced by the moronic posts immediately following OP.
     
  24. vvvmd

    vvvmd F1 Rookie
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    A lot of very angry people on this thread. A lot of people wanting to kick some a$$. Very counter productive. Agree with post above about having very little info about all the details of the case. Sounds like the original poster is POed and wants something done. The first thing I do with angry patients that start to threaten me is ship them to another hospital. Angry people are difficult to reason with and stop listening to any thing they don't want to hear. A lot of poeple just get off on being angry.
     
  25. TexasF355F1

    TexasF355F1 Four Time F1 World Champ
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    I would say it's more emotionally charged than angry.

    The OP just wants some answers and it sounds like he's getting nothing but the run around.
     
  26. vvvmd

    vvvmd F1 Rookie
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    Thats just it we don't know the whole story. Why is his future inlaw in the hospital whats the Dx. Why can't he swallow? What else is being done. What kind of Doc was on call. Did the doc know enough about the patient to make a therapuetic decission? Lots and lots of questions. Very limited info. I oofered to help him out with a PM no responce.
     
  27. Sfumato

    Sfumato F1 Veteran
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    It'd be great if we knew the full story. OP sounds like a worried kid new to family, trying to support s/o, asked advice.
    Maser has spoken, we can all slink away now. Kerist, this is like the doc's lounge.

    I'd love to have a place to ship all the annoyed people, but I practice pretty much at end of funnel. You take what you get. However, my point, made bluntly, is we all need to communicate, no matter 7AM or 11PM or 3AM.

    Only doctor bashing I did was for the ones who don't do the job they're supposed to, and a/my patient doesn't get what they need appropriately and timely.

    We MD's can't kick a$$ like our forebearers, but families can and do. Averting that and making a family feel at least attended to is the goal.

    "Make'em better, or make'em happy. Or both."
     
  28. TexasF355F1

    TexasF355F1 Four Time F1 World Champ
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    Completely understand and agree.
     

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