illegal or just unethical?

[Unregistered]

My elderly mother is sick with a cough and runny nose. She said she needed to go to the doctor.

I've been working all day, and I said I would take her when I got back. When I got there, she had a bottle of Cipro. I asked her what happened, and she said she called her doctor. That doc wasn't there, so the nurse asked another doctor what to do. Sight unseen, and without even talking on the phone, that other doctor gave her a prescription, and the pharmacy delivered it.

Perhaps he thought he was being kind to an old lady, but I am ****ed.

 

[bbchien]

Well, would you rather have them to have said, "We'll have a look at you when you get here, we can't do a thing until then".

Many docs will do that....and then some one always says, "I'll sue the bas_ard, he should just call in a prescription...."

 

[kyleb]

I'm a long term patient with my GP. He knows that I get horrible sinus infections 3-4times a year. We're at a point where he knows I can self diagnose the problem, and he is willing to call in a prescription without a trip to his office.

Maybe your mom's relationship with her doctor's practice is similar.

That would be a good thing.

 

[Unregistered]

Well, would you rather have them to have said, "We'll have a look at you when you get here, we can't do a thing until then".

Many docs will do that....and then some one always says, "I'll sue the bas_ard, he should just call in a prescription...."

I see your point, doc, but what if this isn't what she needs? She's reading all the warnings, and she's already taken a pill with milk, etc.

I'm still going to have to take her in, but they can't see her until Monday.

I have a few friends who are physicians. Maybe I'll take one out to lunch if they'll stop by and at least take a look. . . .

 

[Unregistered]

I'm a long term patient with my GP. He knows that I get horrible sinus infections 3-4times a year. We're at a point where he knows I can self diagnose the problem, and he is willing to call in a prescription without a trip to his office.

Maybe your mom's relationship with her doctor's practice is similar.

That would be a good thing.

It is, but this isn't her doctor. And he didn't even speak with her over the phone.

If it had been her doctor, I would have felt better.

 

[bbchien]

Welll then you needed to take sick leave off of work DURING the day and get 'er done.
I'm sorry you feel pi**ed but the bottom line is that they TRIED, whomever the partner doc is obviously looked at the record.

HER DOC can't be available all the time and neither can you. So it's OKAY if you can't be there to take her to the doc, when YOU are busy, but it's NOT okay for him to be away when YOU need him to be there.

What am I missing?
Or is the real title of this sting: It's OKAY for me to be busy, but it's not okay for the Doc to have a LIFE. Hmmmn.

Now just who is unethical here? The Parter doc who doesn't meet your standards? Or the faithful son who doesn't take time off work (in a timely manner) to help his mom (and then is ****ed off at other parties)?

I'm being VERY brutal here, but I think I need to do so, so you can "get it". I'm sure not going to contribute any more to a string with such a PREJUDICIAL title.

 

[Unregistered]

Welll then you needed to take sick leave off of work DURING the day and get 'er done.
I'm sorry you feel pi**ed but the bottom line is that they TRIED, whomever the partner doc is obviously looked at the record.

HER DOC can't be available all the time and neither can you. So it's OKAY if you can't be there to take her to the doc, when YOU are busy, but it's NOT okay for him to be away when YOU need him to be there.

What am I missing?
Or is the real title of this sting: It's OKAY for me to be busy, but it's not okay for the Doc to have a LIFE. Hmmmn.

No, you miss my point. I'm simply worried that it is the wrong medication, or could harm her. She isn't in dire straits, and only had to wait 4 or 5 hours.

But I do feel, better, because you point out that this second doc must have looked at the records. Since I would have been perfectly happy with my mom's regular doc prescribing over the phone, and since I now realize this second doc did due diligence, I fell better.

Thanks, Doc Bruce. I sincerely appreciate it!

 

[Unregistered]

I'm simply worried that it is the wrong medication, or could harm her. She isn't in dire straits, and only had to wait 4 or 5 hours.

But I do feel, better, because you point out that this second doc must have looked at the records. Since I would have been perfectly happy with my mom's regular doc prescribing over the phone, and since I now realize this second doc did due diligence, I feel better. And I do realize that the second doc had good intentions, and I appreciate that.
[/QUOTE]

 

[Unregistered]

I'm simply worried that it is the wrong medication, or could harm her. She isn't in dire straits, and only had to wait 4 or 5 hours.

But I do feel, better, because you point out that this second doc must have looked at the records. Since I would have been perfectly happy with my mom's regular doc prescribing over the phone, and since I now realize this second doc did due diligence, I feel better. And I do realize that the second doc had good intentions, and I appreciate that.

 

[GBear286]

This is an example of why antibiotic resistance is such a big problem. It's not bad enough that they are prescribed far too often in person but now we are doing it over the phone. We have bugs now that are pretty much resistant to everything.

 

[Unregistered]

Sorry for the triple reply. Thought I was editing.

Thanks again, Doctor Bruce!

 

[bbchien]

So, for the OP: Imagine the situation from the doc's end.
Say she has recurrent episodes of pulmonary infections. Maybe this is one! ? Time to treatment is critical. He makes his best guess.

Now say he had elected to wait until she appeared at the office. Now say she's really really sick and need the hospital. Remember, Jim Henson (Muppet fame) died OVERNIGHT the next AM. Now how do you feel?

Now imagine that she has an adverse reaction. How does the doc feel?

That is why, many docs will simply say, "We'll deal with it when the patient appears, we can't do anything else". In the situation, the doc who called in the Rx, took a medicolegal risk because he thought it was appropriate.

In addition his practice doesn't collect a THING to pay for that liability premium!!

And then you start a sting entitled, "ILLEGAL or UNETHICAL?"

You really should be thankful that the guy has the b_lls to do this...for your Mom.
Even if she (you) had showed, Medicare would have paid him about $18.50 for the trouble. I would tend to think, "this covering partner tried to be a good guy".

 

[Everskyward]

There are probably some other issues here too. Many elderly people are not easily able to make it to the doctor in a timely manner. What should they do? Are they still able to make their own medical decisions stating whether or not they want the prescription by phone?

 

[Unregistered]

So, for the OP: Imagine the situation from the doc's end.
Say she has recurrent episodes of pulmonary infections. Maybe this is one! ? Time to treatment is critical. He makes his best guess.

Now say he had elected to wait until she appeared at the office. Now say she's really really sick and need the hospital. Remember, Jim Henson (Muppet fame) died OVERNIGHT the next AM. Now how do you feel?

Now imagine that she has an adverse reaction. How does the doc feel?

That is why, many docs will simply say, "We'll deal with it when the patient appears, we can't do anything else". In the situation, the doc who called in the Rx, took a medicolegal risk because he thought it was appropriate.

In addition his practice doesn't collect a THING to pay for that liability premium!!

And then you start a sting entitled, "ILLEGAL or UNETHICAL?"

You really should be thankful that the guy has the b_lls to do this...for your Mom.
Even if she (you) had showed, Medicare would have paid him about $18.50 for the trouble. I would tend to think, "this covering partner tried to be a good guy".

Doc, you've made your point, and I agree with you.

I have to take off work about two or three times a week for her, and I do appreciate what the partner did, now that you've put it into perspective for me.

Thanks.

 

[kgruber]

My elderly mother is sick with a cough and runny nose. She said she needed to go to the doctor.

I've been working all day, and I said I would take her when I got back. When I got there, she had a bottle of Cipro. I asked her what happened, and she said she called her doctor. That doc wasn't there, so the nurse asked another doctor what to do. Sight unseen, and without even talking on the phone, that other doctor gave her a prescription, and the pharmacy delivered it.

Perhaps he thought he was being kind to an old lady, but I am ****ed.

Neither...........Just great professional service. We lack so much of that today.

 

[GBear286]

Neither...........Just great professional service. We lack so much of that today.

I disagree. Bad medicine in my humble opinion. There are better options. Why not get a home health nurse to go check on the patient and call the doc?

 

[bbchien]

There are probably some other issues here too. Many elderly people are not easily able to make it to the doctor in a timely manner. What should they do? Are they still able to make their own medical decisions stating whether or not they want the prescription by phone?

You're talking about....MY FOLKS!

This is the entire crux of the middle generation attempting to do elder care. We work. We support the kids. We are still healthy enough to do everything but our "Urgent Response" for the folks...can be....what- eight hours at times?

Yet the folks might just not want or be ready for elder care in the residential setting where this stuff is dealt with and available. I vivdly recall my mom saying about six years ago- "you'll take me out of this house over my dead body!".

There are no answers. Even the current administration has no answer for this one.

To Gary:

I disagree. Bad medicine in my humble opinion. There are better options. Why not get a home health nurse to go check on the patient and call the doc?

You're going to opine that without the chart? Way outta bounds.

Home Health Nurse? When they're not on a rehab or recovery program (say an ostomy nurse?). Where's the funding for that? Obtain same on a Saturday? From which planet did you last vacate? You're talking essentially ER eval. in your home. Medicare certainly doesn't pay for that.

At $18.00 the doc is not going to make a house call, Gary. Cardiologists still make a good bit from the professional fee related to technologic medicine (though not for long- have you seen the 2013 rates? ). FP's don't have that. And as an Ex I.D fellow in between I.Med. and Anesthesiology, I do agree as to antibiotics. But how're ya gonna get a sputum for gram stain, and the CXR, maybe even the CBC, when Mom is relying on you to get home to take her there.....

 

[Unregistered]

. . . Why not get a home health nurse to go check on the patient and call the doc?

OP, here. My mother and I have been discussing that option these days. I check in on her every day, because I live half a mile away, but a nurse might be a good idea.

 

[wsuffa]

You're talking about....MY FOLKS!

This is the entire crux of the middle generation attempting to do elder care. We work. We support the kids. We are still healthy enough to do everything but our "Urgent Response" for the folks...can be....what- eight hours at times?

Yet the folks might just not want or be ready for elder care in the rsidential setting where this stuff is dealt with and available. I vivdly recall my mom saying about six years ago- "you'll take me out of this house over my dead body!".

There are no answers. Even the current administration has no answer for this one.

BTDT. The corollary is: "I can take care of (my spouse), so no need for assisted living".... while not admitting that the (spouse) is sicker than they think.

Even in the elder care residential setting, some of them learn that complaining about a suboptimal medical condition may earn them a ride to the ER.... they learn to just not complain if they want to avoid that ride.

Sigh.

 

[Geico266]

My elderly mother is sick with a cough and runny nose. She said she needed to go to the doctor.

I've been working all day, and I said I would take her when I got back. When I got there, she had a bottle of Cipro. I asked her what happened, and she said she called her doctor. That doc wasn't there, so the nurse asked another doctor what to do. Sight unseen, and without even talking on the phone, that other doctor gave her a prescription, and the pharmacy delivered it.

Perhaps he thought he was being kind to an old lady, but I am ****ed.

Are you kidding me? Be damn glad the DR. And Nurse have a brain. Antibiotics were appropriate.

You should be arrested and charged with elderly neglect. You chose work over taking a sick elderly person to the DR? 3- 6 months in the slammer if I were the judge.

 

[Everskyward]

There are no answers. Even the current administration has no answer for this one.

Totally agree with this. It's coming for the boomer generation, and many do not have children close by, or at all, to manage their care. Assisted living and private care is a partial answer but I will tell you that it is very, very expensive.

 

[douglas393]

My two cents:

We are missing a lot of information hers. Antibiotics for a runny nose and a cough? Probably viral and if so then antibiotics are overkill and possibly dangerous. Ciprofloxacin is not without its dangers and treating everything with antibiotics is so how do I say it 1980's. Without further information I think the doctor did her a disservice. I also think making the jump from this to dying the next day from pneumonia is somewhat of a stretch. If I remember correctly, there was a lot more to what happened to Jim Henson. Now if the OP's mother had a history of bacterial sinusitus, or community aquired pneumonia and has been treated with ciprofloxacin before then the treatment is probably appropriate.

Just my two cents.

DOug

 

[bbchien]

See bottom half of post #17. Opining without the chart is a big leap....

 

[douglas393]

See bottom half of post #17. Opining without the chart is a big leap....

I agree opining without the chart is a big leap. Thus my post I think we need more information here. I still think you will agree that throwing antibiotics at every runny nose and cough is probably bad practice as the vast majority will be viral and at best antibiotics will be worthless and at worst well ....

Doug

 

[GBear286]

Y

To Gary:
You're going to opine that without the chart? Way outta bounds.

Home Health Nurse? When they're not on a rehab or recovery program (say an ostomy nurse?). Where's the funding for that? Obtain same on a Saturday? From which planet did you last vacate? You're talking essentially ER eval. in your home. Medicare certainly doesn't pay for that.

At $18.00 the doc is not going to make a house call, Gary. Cardiologists still make a good bit from the professional fee related to technologic medicine (though not for long- have you seen the 2013 rates? ). FP's don't have that. And as an Ex I.D fellow in between I.Med. and Anesthesiology, I do agree as to antibiotics. But how're ya gonna get a sputum for gram stain, and the CXR, maybe even the CBC, when Mom is relying on you to get home to take her there.....

I saw this one coming. I said it was my opinion nothing more. I can't say I blame the primary care physician. They are under-compensated and overworked. Primary care is in many ways more difficult than specialty medicine. Based on the OP's post I doubt that the physician had enough information to distinguish between the different possible diagnoses or determine it's severity with a reasonable degree of certainty. Unfortunately, the alternative may have been for the patient to go to the ED by taxi, wait for hours and still come home with a bottle of cipro.
I am aware that reimbursements are way down. My pay has dropped about 30% over the past 3 years but that's just the way it is.

 

[kgruber]

I disagree. Bad medicine in my humble opinion. There are better options. Why not get a home health nurse to go check on the patient and call the doc?

And then have the "home health nurse" spend 45 minutes writing down all the details of the encounter. All for the lawyers.

 

[Unregistered]

Are you kidding me? Be damn glad the DR. And Nurse have a brain. Antibiotics were appropriate.

You should be arrested and charged with elderly neglect. You chose work over taking a sick elderly person to the DR? 3- 6 months in the slammer if I were the judge.

You need to read my posts. I am there EVERY day. I was already at work when she called, and she said she "had a cold."

I make dinner for her, walk her dogs, etc. I am there every day, because I care about her and love her.

You don't know me, but you've decided to throw me in jail.

 

[Unregistered]

OP here.

Since this has sparked some interest, I will fill in some of the blanks.

My mother is 73 years old. So of course she has in her life had bacterial respiratory infections. She doesn't have what I'd call a history of them, in that they are regularly occurring.

I do have access to her medical records, as she's signed a waiver for me so I can talk with the doc about her health.

The pattern is usually a couple of colds a year--usually just a cold--but she -demands- antibiotics, because she's simply convinced that she needs them, even when the doc says she doesn't. I've tried to tell her that a viral infection probably won't respond to antibiotics, but she doesn't get it.

And THAT, my friends, is why I was frustrated. She is sick, and probably has the WRONG medicine. But again, after reading Doc Bruce's explanation, I now understand that position.

By the way, I am allergic to many antibiotics, and since a Stevens Johnson Syndrome episode at age 24 which put me into the hospital for 4 days, I have NEVER taken them. That's 20 years of coughs and colds with nary an antibiotic. If I ever had to take them, I would have to do so in the hospital under observation.

 

[GBear286]

Are you kidding me? Be damn glad the DR. And Nurse have a brain. Antibiotics were appropriate.

You should be arrested and charged with elderly neglect. You chose work over taking a sick elderly person to the DR? 3- 6 months in the slammer if I were the judge.

Oh please. We may be on the same side most of the time in the SZ but you are probably wrong here.

OP here.

Since this has sparked some interest, I will fill in some of the blanks.

My mother is 73 years old. So of course she has in her life had bacterial respiratory infections. She doesn't have what I'd call a history of them, in that they are regularly occurring.

I do have access to her medical records, as she's signed a waiver for me so I can talk with the doc about her health.

The pattern is usually a couple of colds a year--usually just a cold--but she -demands- antibiotics, because she's simply convinced that she needs them, even when the doc says she doesn't. I've tried to tell her that a viral infection probably won't respond to antibiotics, but she doesn't get it.

And THAT, my friends, is why I was frustrated. She is sick, and probably has the WRONG medicine. But again, after reading Doc Bruce's explanation, I now understand that position.

By the way, I am allergic to many antibiotics, and since a Stevens Johnson Syndrome episode at age 24 which put me into the hospital for 4 days, I have NEVER taken them. That's 20 years of coughs and colds with nary an antibiotic. If I ever had to take them, I would have to do so in the hospital under observation.

Here's a true story about my mom. She is in her 70s and always demanded antibiotics for colds and her physician complied. She eventually got sick with diarrhea. Her primary sent her to a gastroenterologist who promptly did a colonoscopy and diagnosed her with a rare form of colitis and prescribed an expensive medication. Over the next few months she got worse and was so weak she could hardly get out of bed. She was admitted to her local hospital. I flew down to see her and it was obvious she would die if she didn't start to improve soon. I convinced her physician to arrange a transfer to the University of Alabama Birmingham hospital. Shortly after she arrived an internal medicine intern showed up and ordered the basic tests. Long story short she was diagnosed with clostridium difficle colitis which is a complication of one of those antibiotics she took for colds. She was discharged home the next day and got better within days. An intern with a Washington Manual was smarter than a GI specialist who chose the most lucrative test. Mom won't touch an antibiotic unless she is diagnosed (in person) with a life threatening infection.

 

[Geico266]

Oh please. We may be on the same side most of the time in the SZ but you are probably wrong here.

I take child and elderly abuse / neglect very seriously. Way too much of it.

I just call um as I see um. 3-6 months in jail would send a strong message to pick the health care of an elderly person over work. Harsh? So is dying of a preventable disease.

 

[GBear286]

I take child and elderly abuse / neglect very seriously. Way too much of it.

I just call um as I see um. 3-6 months in jail would send a strong message to pick the health care of an elderly person over work. Harsh? So is dying of a preventable disease.

I must be missing something. His mom had the sniffles and you want him arrested for not doing what? Calling 911? Leaving work early to take her to the ED? This thread illustrates many problems but elder abuse is not one of them.

 

[GBear286]

In response to the original question: Illegal or unethical, in my opinion neither, just not a good way to practice.

 

[Geico266]

My elderly mother is sick with a cough and runny nose. She said she needed to go to the doctor.

.

The OP stated in the first sentence of his post that she said "she needed to go to the doctor". He chose work over taking an elderly person to the doctor. That is neglect in my book.

She was scared enough about her condition that she called the DR instead of waiting for her son to come home from work. This is more neglect in my book.

Then the OP gets all ethical and wonders if the DR / nurse did something wrong.

JMHO.

 

[GBear286]

The OP stated in the first sentence of his post that she said "she needed to go to the doctor". He chose work over taking an elderly person to the doctor. That is neglect in my book.

She was scared enough about her condition that she called the DR instead of waiting for her son to come home from work. This is more neglect in my book.

Then the OP gets all ethical and wonders if the DR / nurse did something wrong.

JMHO.

If you are not an attorney maybe you should go to law school. Just don't become a prosecutor or the jails will be full of innocent people. It is apparent that his mom had some bothersome but apparently minor symptoms and thought she could use some antibiotics. Every primary care physician has loads of this type of patient who call periodically wanting something they probably don't need. If his mom told the OP she was having crushing chest pain or was so short of breath that she was having difficulty speaking that would be different.

 

[Jthamilton]

Ever heard of an after hours clinic?

Although not my typical method of handling phone calls, this happens all the time, so don't act naive that some great law has been broken.

We fight this everyday on both sides. "Mrs. X called and wants a z-pack called in" or the " I paid my copay and I expect an antibiotic, its the only thing that fixes this!" This happens every single day in America. The public is under the conclusion that medicine is a service they can handle on their own with a phone call. Parents and caretakers conclude that their loved ones received sub par care because an antibiotic wasn't given.

We don't like dealing with calls, time spent on a phone instead of a room doesn't pay the bills. My nurse on a phone with some one not willing to come to the office takes away from the person who respects the appt. process and is waiting on me to come in. Healthcare isn't the easiest business in America to make a dollar and like any business you spend your time on things that help you earn a living for your staff.

Sending a home health nurse to see a probable head cold would only occur in Fantasy land!

I don't applaud the physicians action but I understand them completely. Nurses can ask the same questions I would pertaining to the medical history. The nurse may know the patient very well and offered the prescribing physician very good information. What kind of response would you have given to her being told to use nasal saline and an anti-inflammatory throughout the weekend until she could be seen Monday?

Cipro is a very good antibiotic for sinus and pulmonary maladies along with urinary and certain GI situations so odds are in the rare instance she even needed an abx it's probably covered. C. Difficile can occur with many antibiotics and usually doesn't occur with a short single course.

I hope she does well, next time please consider the post. Some physician who doesn't know your mother had a discussion with a nurse who might and attempted to help her! Hmmm stranger helping someone out, not always right but seems like a good thing, especially an elderly person.

 

[bbchien]

...and so the tale is told. there is no solution to this. As our economy declines into the 3rd world stagnation reminiscent of Harold Wilson's England, it will only get worse.

There are always two sides to every story, in this case three or four....

Incidently, Gary F, I did a U of Chicago Infectious Disease Fellowship. The principal reservoir of resistive bacteria is in our stockyards where the cattle go after three years of erythromycin containing feed. That's not to minimize inappropriate antibiotic use, either.

But I think the tone of my post, #12, does capture the problem. I was only "hard" on the OP because I wanted him to see the view from hoof and knee level, not from the high horse. I think everyone here "gets it", including Okie182, who knows the problem with the after hours clinic- no access to the history of repetitive tough times with bronchitis/bronchiectasis or repetitive micro aspiration or WHATEVER the source of the repetitive difficulty has been.

(Former disciple of Sidney Feingold MD)
FACP, Asst. Prof. of Medicine U of I.

 

[fnpdoc]

Antibiotics are NOT indicated for acute sinusitis. He is not doing you any favors.

I'm a long term patient with my GP. He knows that I get horrible sinus infections 3-4times a year. We're at a point where he knows I can self diagnose the problem, and he is willing to call in a prescription without a trip to his office.

Maybe your mom's relationship with her doctor's practice is similar.

That would be a good thing.

 

[fnpdoc]

You are wrong. More likely than not, antibiotics were not indicated. I would not prescribe them with this story. Especially cipro.

I take child and elderly abuse / neglect very seriously. Way too much of it.

I just call um as I see um. 3-6 months in jail would send a strong message to pick the health care of an elderly person over work. Harsh? So is dying of a preventable disease.

 

[Henning]

Well, would you rather have them to have said, "We'll have a look at you when you get here, we can't do a thing until then".

Many docs will do that....and then some one always says, "I'll sue the bas_ard, he should just call in a prescription...."

All you can do is what you can do. Personally I prefer to be able to make an emergency phone call and a run to the pharmacy than a trip to emergency room for an infection.

 

[Henning]

I see your point, doc, but what if this isn't what she needs? She's reading all the warnings, and she's already taken a pill with milk, etc.

I'm still going to have to take her in, but they can't see her until Monday.

I have a few friends who are physicians. Maybe I'll take one out to lunch if they'll stop by and at least take a look. . . .

Your mom has a cold which likely there is no help for at this point besides the usual symptom relief stuff. They could likely have done nothing, however on the odd chance that there was a bacterial element developing he prescribed a solid antibiotic that at her age will have no deleterious effect if she did not need it and will save her life if she did. So in the end of it, there was a doctor on the other end of the phone writing a prescription and assuming liability, likely for no recompense, just looking out for your moms best interest.