Juliet Siena Okoroh MS4 PRIME at UCSD SOM
Mr. Right is an African American male in the VA that I saw with terminal cancer.
What are we going to do for him?
He complains of weakness today.
This is likely due to his underlying prostate cancer.
On chart review:
Hematology-Oncology, Palliative Care, Home Health, Care Coordination have all signed off either due to patient “ not compliant” “missing appointments” and “ refusing care.”
It is time for me to see him.
Hello Mr. Right, how are you?
I feel weak, there is pain when I have bowel movements and I need medications.
Mr. Right was here the previous week seeking pain medications and was asked to return home to see how many narcotics he had left from his last prescription.
To me, he appeared to be a bit slowed in his response to my questions, occasionally forgetting the questions asked.
I presented him to my attending who also did not understand why Mr. Right had a long history of skipping appointments as well as 40 emergency department visits in 10 months.
I suppose Mr. Right may have a component of dementia, let us do a SLUM test to confirm given he has a history of cognitive impairment.
My SLUM examination of Mr. Right revealed he had dementia. (15/30) Off course he skip appointments because he forgets them
On discussion with Mr. Right he states “ I would make it to my appointment if I knew I had one.”
My goodness, would the health system we call the United States even the VA give Mr. Right a chance? A man who devoted his life to protecting the rights of citizens of this country. Yet we document he is non-compliant only to find out he has no support systems in place, cannot remember appointments because of his dementia, and he is homeless and unemployed.
I made an emergent appointment with Mr. Right’s primary care doctor and sent an email requesting for him to be further considered for home primary care if possible.
I spoke with the social worker to obtain a geriatric -psychiatry appointment for him.
I wrote on a large piece of paper, the date and time of his appointment and asked him to put a reminder in his phone.
With this I was satisfied Mr. Right will finally be seen by someone who will take care of him.
Now all I have to do is follow-up.
I called Mr. Right twice in order to remind him of his upcoming appointment.
His number was out of service.
I should have verified he had a phone and a working phone number.