I only wish the headline was true. It is, though, what is happening to the
No Child Left Behind law because it has caused nothing but headaches due to teaching to the test. President Barack Obama signed an executive order allowing states to request waivers from mandatory participation in the program Right now at least 27 states are going to opt out. The same problems the states have with this law is the same problem doctors are having and will have with pay-for-performance. It is bad for patients and bad for doctors. It takes the art out of medicine.
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So why are ER docs and hospitalists admitting them then? The same problem occurs when the same patients show up from home. Some geriatric education and social work help in information gathering for ER docs would help, (how can you know if mental status isn't really "altered" if you don't have time to figure out a baseline?), but only if there is some disincentive to admit as well.
I quit doing ER in 1996, and back then I could never get anyone admitted without going through a grueling process of explaining exactly why to a primary care doc who sometimes knew the patient and preferred not to have another thing to do in the hospital the next day. I think they were too hard on me but it made me a "wall". Does that slang term even still exist? If so studies show it doesn't apply to anyone over 80.
As an NP in LTC, I can tell you that we strive to keep our residents in the facility. You hit it on the head when you stated that families most often drive the decision to send the patient to the ER. As I am oncall 24/7, including weekends, for my 2 facilities, we don't have much of the on-call physician problem. I understand their point though... families do sue mostly due to unrealistic expectations of what can be done to help their loved one. I try to work on those expectations during conversations long before the crisis point. It helps... sometimes. It is amazing how many severely demented people are still full codes because of family decision-making. Tort reform in this area would also make a huge difference. That being said, sometimes the staff just can't handle the care needed for someone acutely ill. Our LPNs have patient loads of 30-34 each. Try to keep track of that many meds and needs... almost impossible but they come back and do it every day.
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