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The Dangers of “Just to be Safe”

June 11, 2011

We have a family friend who’s a 91-year-old feisty woman proud of her independence. She’s lived in the same house alone for five decades, many of them with only her canine companion. Her husband died decades ago and she never remarried. She has little medical history to speak of, but she felt bad a week ago, told her friends she was having chest pain, coughed a lot, and her friends noticed she was much different from her usual self. She saw her physician who diagnosed her with pneumonia and admitted her to a standard acute care hospital. She was in for a few days surrounded by a cadre of younger friends and neighbors she had developed close relationships with over the years.

Her condition improved in mundane fashion and when talk of discharge from the hospital began she wanted to go home, but her friends wanted her to go to a rehab facility for a few days to get some sort of therapy they thought would help her get back on her feet. The rationale for the therapy was “just to be safe.” Hospital personnel recommended this transfer also. She clearly was not feeling 100% back to normal, because this time she actually did what her friends wanted and went to the rehab hospital.

The rehab facility is part of a national chain and has a good local reputation. She was unimpressed from the first day. As part of their standard package, she had to have so many hours per day of occupational therapy. It started with activities such as putting square pegs in square holes. She quickly moved through all the activities occupational therapy had to offer. Cookbook approaches sometimes mean patients receive services that make no sense to their individual situations.

They also made her wake on their schedule and eat even when she told them she wasn’t hungry. Mealtimes usually consisted of sitting in a wheelchair with three other patients who either couldn’t speak well or who had dementia. She can walk without assistance but has bad vision, so the policy of the facility was that she had to be transported by a wheelchair.

Occupational therapy and forced eating was insulting but other interactions were life-threatening. The facility gave her medicines based on a list transferred from another facility’s electronic medical record. She informed them that the medications were wrong but they ignored her, assuming this 91-year-old woman was just confused and not playing with a full deck. Two days after entering the rehab facility her blood pressure was 76/40 and she had to go back to the acute care hospital she started at. The rehab facility was giving her an old medication regimen she was no longer prescribed, but was a list the EMR had.

After going through this saga with her, her friends became convinced that further therapy was not such a good idea. Everyone let out a soft cheer when her doctor said she could be discharged home. Nothing like feeding the dog, making the bed, preparing meals, and visiting with friends to work out the last bit of rust from a case of pneumonia.

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One Response to The Dangers of “Just to be Safe”

  1. Christopher Gregory on June 14, 2011 at 12:30 pm

    Where’s all of this wonderful information linkage that’s supposed to prevent med mistakes? Why was her primary care doctor not able to intercept the error(s?

    This sounds like a comedy of errors – medicine matched to bureaucracy – not to the patient.

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