Between Hospital and Home

Re: Matthew Weinstock's Health Matters column, "Smooth Transitions," in the January issue:

Yours was a common problem of persons being discharged from the hospital too quickly, which could have been better remedied by a two-week stay in a nursing home to receive the necessary training, follow-up care, and therapy. It may have prevented the second hospitalization. I am an administrator of a skilled nursing facility that admits many post-surgical patients for short-term stays to aid in recovery, teaching and aiding returning patients to the presurgical levels of functioning. Nursing homes have evolved, and are not all the same. Many provide rehabilitative services or subacute care that hospitals no longer provide. Medicare offers benefits of up to 100 days of nursing home care for skilled nursing services. It may be worth the time to investigate this as an option to the readmission problem hospitals face.

Alan M. Hull
Heritage Gardens Health Care Center
Loma Linda, Calif.

If Vets Can Make House Calls ...

Re: "A Return to Patient-Focused Care" by Andrew R. Watson, M.D., H&HN Daily, Jan. 31

Large-animal vets have the same if not more schooling required and they acquire the same level of debt for that education, yet most of them are mobile. They travel to their patients because, to be very honest, it would not be reasonable that the animals come to them. I cannot tell you how many times I have worried as I waited for the vet to arrive. It's not usually a good thing when there is an emergency vet call.We have scheduled calls as well that are not urgent [such as] vaccinations, new foals and follow-ups. … I just wonder if it doesn't make sense to have the old farm doctor model return for primary care.

The house call doesn't sound so bad, and when you visit the home, you see more than in the clinic. What is it that House does on TV?; [he] goes to the home to see what is causing the strange and difficult diagnostic symptoms/disease.

I see a transition happening in the U.S. medical field. We are shifting the model. For the majority of the population, this is good. There are some cases that require more, and we need to be able to be flexible to address those needs as well.

Interesting article; made me think about advising my teenager to be a primary care doctor who maybe does make house calls.


When a Patient Is in Pain

Re: "Let's Relieve America's Epidemic of Pain" by Bill Santamour, H&HN Daily, Feb. 6

The nursing schools teach nurses how to be patient advocates. That includes helping to alleviate the pain when subjective or objective data present themselves. Pain control is now the fifth vital sign. Not helping a patient with his or her pain goes against everything we are taught or understand by nature. However, you are correct when you state that med schools do not teach their students (including residency programs) how to care for chronic pain patients. After 20 years of critical care bedside nursing, I continue to be astounded when board-certified physicians fail to recognize and effectively treat pain in the patient population. My pleas go against deaf ears for a multitude of reasons. My hands become tied.

Shirley Mayfield, R.N., CLNC

The Dental Dilemma

Re: "Access to Dental Care: A National Scandal" by Emily Friedman, H&HN Daily, Feb. 9

The lack of dental coverage for children and adults is an embarrassment to the American health system. My son is a young adult cancer survivor. Thankfully, his medical coverage was still covered under my plan, but he has no access to dental insurance. A side effect of his radiation treatment is that he has a cavity in every single tooth.

Medical insurance will not cover it. We are paying more to fix his teeth than we paid for his cancer treatment. We also have a family friend who is self-employed and a cancer survivor and has the same side effect of radiation. He is in the same dental financial situation.