Dr. M. and I are members of the same congregation. At the coffee hour after services, I mentioned to her an incident in which I took an elderly patient to a doctor appointment and found she had been there two days before!   I expressed my concern about the implications of this confusion for the patient, her treatment, the clinic system reimbursement, and its effect on outcomes.   Dr. M. said these situations had occurred in her practice as well. As we discussed my case further, we realized we both had the same patient!   This patient had been seen at two different branches of the same medical system! Neither branch’s staff knew who brought her. In both appointments, the patient could not describe why she was seeing the doctor or how she got there. In the visit I arranged, I came in (our policy) and reported the reason for the appointment. However, I discovered that there were at least two state agencies involved with this family and both denied making the first appointment. One state agency had even asked me to make (the second) appointment. This is good example of the limits of reliance on elderly patient self-reporting.   It has implications for the health care system and reimbursements.

Dr. M. indicated that she had also seen nursing facility patients with poor self-reporting. In my years of practice as a Medical Visit Companion, I have continued to take to patients to visits after they entered nursing homes.  I noted that each facility sends a copy of medicines and treatments but does not always include the reason for the visit. The staff might tell me why; the patients never did.

One of my nursing home cases, I had to drive to the appointment separately. I left after seeing the patient loaded into the transport van. I told the driver I would be there to meet them. 45 minutes later, my patient was missing! I called the transport company; they had taken her to the wrong office! Thus, relying on transport drivers is not a dependable plan for patients who cannot self-report or self-direct.

An increasing elderly population will increase this incidence of patients who poorly self-report. I believe it will have a direct bearing on outcomes, and on reimbursement for all sectors of healthcare.  Identifying problems like this case will help us make modifications.  Our healthcare system needs a method to compensate for inadequate patient self-reporting.  I have some ideas about how to fill that niche; stay tuned.


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