So, as I mentioned in the original post about Changing Mom’s Physician, we are transitioning to a service where the healthcare professional comes to you. This is needed as Mom’s Post Polio Syndrome and congestive heart failure has progressed to the point where it is beyond exhausting for her to venture out of the house. She will sleep for two whole days to recover, literally.
So, the service sent a female practitioner, as requested, but who they sent was a Nurse Practitioner instead of a doctor. During the first visit, her assistant took Mom’s vitals and drew blood for a full workup. The NP sat with me to get a complete list of Mom’s medications. The final medication I mentioned was the pain pill. Mom’s previous physician of 3+ years had been prescribing Oxycodone to take “as needed”. This has worked very well for Mom. Last refill of 60 tablets was back in early April and Mom still has about half of them remaining. Mom is very judicial about taking them, only doing it as a “last resort”. That woman has such a huge threshold for tolerating pain. I don’t know how she does it.
Anyway, the NP jumped all over that. “Oh no. That is not how I would prescribe the pain medication for her. She needs a much lower dose and to take it daily”.
I was stunned…. “Uhhhhhh, excuse me, but you don’t even know Mom! How can you say this?! I can tell you that there is no way Mom is going to agree to take a controlled substance every day for the rest of her life. What is the problem with continuing this medication as is?”
The NP explained that taking the narcotic only sporadically, it will not show up in a urine test. The only way she’ll know that Mom is taking the pain med as prescribed is to require a regular urine test to be certain. My Mom, asked “What? Why?!” The NP actually replied, “I need to know that you are actually taking the narcotic and not selling the pills.”
WHAT?!?!??! We were both stunned this time.
The NP follows that up with “I don’t know what you do with your time when I’m not here.”
They left and Mom went on a rampage… I calmed her down promising her that we can ask for someone else to see her, but let’s give it one more visit to see if maybe this gal was just having a bad day. I checked Mom’s supply of pain medication and assured her that she had plenty to get by for another month or more, when her next appointment would be.
Just last week was her second appointment, on Tuesday. The same NP arrived and after the assistant took Mom’s vitals, the NP spoke to Mom with some information about the blood test results. She shared a result of a test where the “normal range” is 0 to 450 and Mom’s number was at 5,400-something, following up with “so this makes sense why you get chest pains and have difficulty breathing”. We were then interrupted by her accepting a call on her cell phone, followed by a quick “good bye” and no further discussion about the blood test results. Before she left, I asked her to authorize refills for some of her medications, which she promised to do.
The following day (Wednesday), I receive an electronic notice from the pharmacy regarding Mom’s medications. Included with the expected ones, was a prescription that Mom has never had before. Interestingly enough, it was the exact medication and dosage that my Dad has been taking for his thyroid for a while now. I called the pharmacy wondering if there was a mixup that it was showing under Mom’s account. They said they’d check into it.
Two days later it’s Friday and I’m still waiting for a prescription refill that we’ve run out of, and no update about the mystery med. So, I called the agency to speak with the NP. She returned my call at 7pm that night (impressive!).
I asked her about the one I’m waiting on. She reminded me that we spoke about it on Tuesday, that Mom had inquired about possibly increasing the dosage and the NP saying she was not comfortable doing that. Yes, I said, and we agreed to continue at the same dosage. “Oh! OK, so I will submit that then.” (Are you kidding me??!!) I let her know that we were completely out so she would expedite the order.
Next, I mentioned the unexpected prescription. I wondered to her if there was a mixup in their system as that is a medication and dosage that my Dad takes (they use the same healthcare providing service). She said, no it is for your Mom. “So you are comfortable with prescribing something new without discussing it with your patient?”, I asked. Well, I didn’t have the blood test results back after drawing it when we were there on Tuesday. “Um, no, you guys drew the blood at the first visit at the end of June. No blood was taken when you were here 3 days ago.” No, we did it on Tuesday. “Um, I disagree, please check your records.”
OK, oh yes, you are correct! (Yes, I know I am.) “OK, so why did you not talk about the thyroid test result and discuss the potential treatment option directly with Mom while you were here?” She apologized.
So, I asked about details of the test result — I have a thyroid condition myself, so I am pretty knowledgeable about the tests available and what the normal ranges are; as well as having had several conversations with Dad’s doctor about his test results, condition and dosage increases over the past year.
She told me the number and why she is prescribing the dosage. I shared I know my Dad’s number, which is higher than Mom’s and the dosage is exactly what she’s prescribing Mom. She said at that number she gives this dosage, then monitor from there. I shared that Mom is sensitive to medications and she has found her system accepts new ones better introducing a lower dose. On several occasions Mom has had unpleasant reactions to previous “normal dose per test result”. Well, this is what I give for this test result number.
“OK, well, Mom is sleeping right now and I would really prefer that you have the conversation directly with her about the test and the result and the treatment you are recommending because I know she’ll have questions that I wouldn’t be able to answer. ” She agrees to call back on Tuesday, after the holiday.
Good grief!! This relationship is going from bad to worse, I thought.
When Mom did wake up, I shared my conversation. She just shook her head. That’s all I needed to know!
So, I didn’t even wait for her callback and I contacted the healthcare providing service and asked who I needed to speak to if we were interested in changing the practitioner we’d been assigned.
The Practice Manager thanked me for calling, apologized for Mom’s experience and said she’ll get back to us on possible options.
To be continued……