June 7, 2014

Is It Any Surprise Patients Are Non-compliant?

I am again writing about doctors complaining about us as non-compliant patients. This time I am really concerned by what is happening in the health care we are supposed to receive, but seldom do. This time it is when patients are discharged from a hospital. Even when hospitals know that they will be penalized for readmission of the patient within 30 days, they seem to care less.

A 2007 Institute of Medicine report accurately describes the fears and worries that accompany most life-threatening illnesses, regardless of the diagnosis. These include basics like:
  • The physical pain and exhaustion of the condition and its treatment.
  • Not understanding about the diagnosis, treatment options, and how to manage your illness and overall health.
  • Not having family members or other people who can provide emotional support and practical day-to-day help such as performing important household tasks.
  • Not having transportation to medical appointments, pharmacies or other health services.
  • Financial problems, ranging from concerns about health insurance to payments for treatments, or problems paying household bills during and after treatment.
  • Concern for how family members and loved ones are coping.
  • The challenges of changing behaviors to minimize impact of the disease (smoking, exercise, dietary changes, etc.).”
The above is important and includes most of the psychosocial stresses accompanying a crisis as it does with the heroic medical interventions that saved us. Yet these are completely ignored by the hospital staff and physicians when patients are discharged from the hospital.

The author of this blog relates that when she was discharged from the hospital cardiology care unit, “not one of the cardiac nurses, residents or cardiologists who cared for me during my post-heart attack hospitalization had said one word to me about any of the important and commonly experienced psychosocial issues on this list.
  1. Not one of them asked, if I'd be able to afford the fistful of expensive new cardiac meds I'd been prescribed after surviving what doctors call the "widowmaker" heart attack.
  2. Not one asked if there was anybody at home to help take care of me there, or if there was anybody at home who needed me to take care of them.
  3. Not one asked if I'd be returning to a high-stress job, or even if I had enough banked sick time or vacation days to take sufficient time off to recuperate before going back to work.
Such real-life issues are simply not the concern of most of our health care providers.”

It's almost as if they are unaware of the considerable research that suggests ignoring the psychosocial issues of their seriously ill patients increases the risk of poor outcomes and higher hospital readmission rates down the road.”

"Those suffering from psychosocial issues can have difficulty remembering things, concentrating, and making decisions. These mental health problems can also decrease patients' motivation to complete treatment, take their medications, change unhealthy practices such as smoking, and decrease their ability to cope with the demands of a rigorous treatment process... There is also growing evidence that stress can directly interfere with the working of the body's immune system and other functions."

With this outlook on life displayed by health care providers, it is a wonder that anyone survives a trip to the hospital, especially the elderly. Still the doctors fight over who is to care for the patients once they leave the hospital, but even that doesn't happen because hospitals seldom communicate with outside doctors. We have more than just a broken health care system, when one branch of care refuses to communicate with another branch.

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