Tuesday, May 18, 2010
Elderly need advocates to work with flawed system
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi:
I just took my mother home from a nursing home, and I never have seen so many people not give a damn about what they do. First, at the hospital, they just pushed her through and pushed her out of that place as fast as they could like she was a piece of garbage. And it was like they couldn't be bothered with me if I asked somebody something about my mother.
Then they pack her up and send her to some nursing home, and there they got her all messed up by sending over the wrong paperwork. And they sent some of the prescriptions but not all of them, and the ones they did send were wrong. After that, I just took her home and said forget about it.
I want to complain to somebody about all of this, but they talk to you like you have a problem. I'm sick of it, and other people are sick of it, too. If this is what they do to people, I'll keep her at home and do my best. They can send some lawyer chasing after me to pay their bill, but I'm not giving them a penny.
-- Richmond
Believe me when I say, "there are days when I really do know what you mean."
I can recall a time during the 1980s when there was more of a "human" touch that we gradually began to lose in the mid-1990s and early 2000s.
At times, it seems that the interests of the "system" are above the interests of the individual, and it diminishes the person to the level of a profit-and-loss statement. And there are times when the system needs a wake-up call, and it is up to you and me to provide that call.
Yes, even I, who could be considered part of the system, found himself at one time having to do just that.
It was in August 2005, and I was invited to present in front of the Health and Policy Study forum of the House of Representatives.
At that time I was the medical director of Ambulatory Care for Internal Medicine, ran the Home Care department and the Geriatrics Liasion Program at the North Central Bronx Hospital campus of the Jacobi Hospital System for Health and Hospitals Corp. in New York.
Municipal and state financial burdens were stressing the public health system to an extreme degree with broad spending cuts made to staffing. Without some incredible staffers to accept many extra burdens and hold it all together, the system would have simply fallen apart. Everybody knew it.
Well what Congress wanted to hear from me was my impression of how well state and federal money was being spent in my small part of the public hospital health system.
As I presented my comments in the run-up to the presentation, I said very good things about the dedicated people and the outstanding programs we worked hard to provide. Then the august assembly heard something they did not expect nor may have not wanted to hear when I said: "Due to the budget cuts, I am noticing a problematical trend in our clinics in that we do not service patients anymore, we simply process them."
Let's say that you could appreciate the echo in the room for the silence.
But it was true, and we "at the tip of the spear" all knew our "baby" was losing its heart and we were becoming a statistic crunching machine. There was only so much you could do to the system before it would start to fail the "human requirement."
I did have their undivided attention, and because they were well-meaning people, they listened. Their problem was that they were too far removed from the real impact of their decisions.
In time, after another committee and more meetings, changes were made and funds were magically found to effect productive change. The bottom line: We all have to be advocates for our health care system.
Yes, sometimes we have to get their attention and make the system work for us as people. And I really do not think the system is evil: It just needs to be led. I know you may not see this right now, but in many ways, things are slowly beginning to get better now than they were in the late 1990s.
What it really boils down to is what we "old timers" know: It takes somebody who knows exactly what they want for the patient to direct the system instead of having the system direct you. You must clearly express your expectations and direct the system to the patient's fulfillment; left to its own devices, the system spins off in its own direction.
That is what you may have seen with mom. And you should know this: The people who make up the system are good people, just like you and me, trying to do the best they can in the most demanding of all human endeavors -- taking care of another human being.
And they do respond and they do listen and they work within some really tough limitations. Don't give up on the system.
The system needs to hear your frustration or it will not improve. You have a responsibility to be an advocate and work to make it better; do not sit there and stew.
Yes, you had a bad experience. But sit down with people representing whichever hospital Mom was at, and in an orderly and polite way, tell them what happened. I know they will work things out for you.
Then I want you to do something else. If you have the time, do some volunteer work in that hospital -- or any hospital -- and within a few weeks, you will see just what I have been telling you: They are really good people!
Now, you and all of us have a job to do -- the health care system belongs to us. Get busy.
If you have questions for Dr. Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014 or e-mail them to extra@roanoke.com with "Age Matters" in the subject line.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.
