This regards my husband…
I may have shared before that we have seen the same PCP for about 35 years. He retired last year, and we are less than impressed with his replacement.
Also, we changed urologist for my husband due to location, and I actually didn’t really care for the other urologist.(I guess we’re too finicky.)
And… Because of his repeated UTIs, we have added an infectious disease doctor from the hospital into our "inner circle".
And, we have Home Health that comes out to the house.
So, these are my questions…
- Who orders a urine culture?
My husband gets these so often that they come between appointments with any of these doctors. What has been happening I think is that my husband tells the home health nurse about his symptoms, and she takes the urine in for culture. There are ALWAYS over 100,000 gram positive readings. (Am I saying that right?) I’m trying to get this clarified, but I also believe that she then has the results of the culture sent to the PCP, urologist, and ID doctor. Is that "proper" protocol? Our Home Health nurse is very eager and willing to get my husband what he needs, and is willing to do whatever it takes. But I don’t want her to be reprimanded for sending in urine for a culture without a doctors order, if that’s an issue.
- Who will be the doctor to actually decide whether or not the infection will be treated, and if so, with what medication?
It’s our understanding that our urologist defers to the ID doctor, if the infection is either questionable, or definitely needs anabiotic intervention. But I’m not sure how the PCP is involved. The PCPs office called this morning and wanted to know who ordered the urine culture. So if it is the PCP who is supposed to place the order, then it sounds like he’s got his panties in a wad about this.
We are in the process of my H becoming a patient of a nurse practitioner who comes to the home (with MD oversight). Amazingly, she also also does palliative care. We are waiting to be called by her to get H set up with her.
- Once we are with the NP, who comes for home visits, hopefully this will take our new/current/unimpressive PCP out of the mix. But does that mean that the physician that works with the nurse practitioner would need to be the one who diagnoses/prescribes antibiotics for these weird bacteria that he gets so often?
We want the infectious disease doctor to call those shots whenever possible. I just don’t know how all this works together.
The ID doctor certainly would not serve as a PCP because of her specialty, but a PCP does not have the specialized training for the kind of infections in the situation. My H is in.
I’m beginning to get the sinking feeling that the seriousness of my husband’s condition might be an issue concerning what infection the doctor chooses to treat. I worry that whatever doctor is in charge of choosing what to prescribe and when not to prescribe might be somewhat influenced by what would keep my H alive the longest. But that is not his first consideration. He wants to live as long as is possible, of course, but not if he will be miserable.
We have been trying to get palliative care for a few months now, but our hospital has only palliative care providers who work with patients while in hospital. And since our home health nurse has found this nurse practitioner whom she has a great deal of confidence in, and the fact that she does palliative care also, AND comes to the home, that seems a perfect fit. Waiting, waiting, waiting to hear from her.
We understand that hospice is an alternative at this point probably. But my husband has determined that he wants to continue to treat these bad infections, and while basic UTIs can be treated with oral meds while in hospice, the type of meds required for his infections…usually IV…are not allowed with hospice.
So, I’m just trying to untangle / understand how all this works together, while honoring his wishes.
Sorry this is so long. Did any of that make any sense?