transportation for patients?

futuredo32

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    I'm on surgery this month and one of our patients who happens to be mentally ******ed has a laundry list of serious health problems. He lives on disability and only recently got Medicaid and hadn't seen a doctor in years. This patient has just been falling through the cracks for years and years and his health is now pretty bad and I don't know that he could survive falling through the cracks much longer.
    He lives independently in an apartment and seems capable of making doctors appointments to follow-up with outpatient care and he is very interested in taking care of his health now that he has Medicaid. The problem is that he doesn't drive and doesn't really know anyone who would be willing to drive him to appointments. Are there any services for patients like him that provide free or low-cost transportation for out patient medical care? There's a primary care doctor on a bus route that is near the patient's home, but really no speciaists near the bus route (and he's definitely going to need to see quite a few specialists). The attendings and residents I'm working with on the service really know their stuff when it comes to surgery and medicine, but they don't seem to know how to arrange help for this patient so that he can arrange for follow-up care.
     

    Ollie123

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      Any medical social workers on staff?

      We had several at my last job whose primary responsibility was handling things like this. If not, you may want to contact People Inc. or similar organizations. I don't know they could necessarily help directly (though they may), but they could definitely point you in the right direction.
       
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      pingouin

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        Medical (and psych) social worker here..

        1. There's a really good chance he's got a case manager/case worker somewhere. Through the state's Dept of Mental Health, a local disabilities agency, something. That would be the person who proably helped access the apartment, get him the Medicaid and disability, etc. They should be able to assist. Often the case manager's job is to bring to appointments, other times to help arrange transportation through other means.

        2. Hospital social worker as a backup to this. This is what we do, this is what we get paid for. This is the person most likely to figure out who the outside case manager is and work with them to arrange stuff.

        Not sure about other states, but in mine and the one neighboring, the state Medicaid programs have a transportation service available to all medical appointments- psychiatric and otherwise. It's a free service available to most Medicaid recipients, and usually requires 3-5 business days to arrange a non-emergency ride. It's kind of hit-or-miss about patients getting picked up and dropped off on time (if at all sometimes), but it's better than nothing.
         

        whopper

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          The attendings and residents I'm working with on the service really know their stuff when it comes to surgery and medicine, but they don't seem to know how to arrange help for this patient so that he can arrange for follow-up care.

          I don't know the culture of the hospital system your in, but if its anything like the one I'm at, surgeons often times want other factions in the hospital to oversee this--seemingly more so than the other specialties. I'm not blaming them either because surgery is a heck of a lot more demanding in terms of the work, calls etc.

          As mentioned above, the hospital probably has a social/case worker who needs to handle this.
           

          futuredo32

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            I don't know the culture of the hospital system your in, but if its anything like the one I'm at, surgeons often times want other factions in the hospital to oversee this--seemingly more so than the other specialties. I'm not blaming them either because surgery is a heck of a lot more demanding in terms of the work, calls etc.

            As mentioned above, the hospital probably has a social/case worker who needs to handle this.

            The surgery residents I'm working with are the busiest people and hardest workers I have ever met and I understand why they deal with things specifically related to what they are treating the patient for and not too many social issues. All they knew was that the patient was noncompliant for previous medical issues, but they didn't know that the noncompliance was due to lack of insurance and could be due to lack of transportation in the future.
            I did mention a consult for social work, but nothing came of it. I'll mention it again (and again and again). It's hard being just a medical student sometimes, wanting to see that what's best for the patient is done after the patient leaves the hospital for an issue that isn't directly related to what the service is treating this patient for as well as remembering that I'm just a student and trying not to overstep my bounds.

            Thanks so much to everyone for all of the advice.:)
             
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            pingouin

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              Interesting timing..

              I got a call from a M3 today, referring an inpatient to my private practice for a discharge appointment. Apparently the social worker gave her a list of names off the insurance list and asked her to start calling.

              I do think it would be helpful for you to bring up the SW consult idea again, futuredo. Maybe if you offer to talk with the SW yourself? That way you're not adding work to anyone's busy day. It might also give you some practice in coordinating with outside agencies, which you'll do a lot as a psychiatrist.
               

              futuredo32

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                Interesting timing..

                I got a call from a M3 today, referring an inpatient to my private practice for a discharge appointment. Apparently the social worker gave her a list of names off the insurance list and asked her to start calling.
                I think it's great to have students learn about the importance of helping patients to get follow up O/P care. :clap:
                I do think it would be helpful for you to bring up the SW consult idea again, futuredo. Maybe if you offer to talk with the SW yourself? That way you're not adding work to anyone's busy day. It might also give you some practice in coordinating with outside agencies, which you'll do a lot as a psychiatrist.

                Good idea. I will definitely try that. (Making half of my progress note every day about the conversation I had with the patient about the need for future transportation doesn't seem to be working:()

                I've been keeping my eye out for the social workers to at least ask for a phone number/agency name, but we usually round/preround at the crack of dawn or pretty late and the rest of my day is spent in the freezing cold OR, so I have yet to see them. If nothing else, I am post-call on Monday, so I can look on the floors for a social worker or call around myself and at least give the patient a phone number to call after he is discharged. It'd definitely be preferable for a social worker to sit and talk with him about it, but, I guess a phone number is better than nothing.

                Thanks so much for your suggestion:)
                 

                futuredo32

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                  Ha, looks like your neck & my neck are similar in these regards. The social workers for medicine & surgery are no where near as effective as the ones for psychiatry.

                  My progress notes for this patient had a request for a social work consult in capitalized letters, underlined, and really big letters (that got bigger every day) that just jumped out of the page and one doctor(I couldn't read the writing, I don't know what service wrote for it) finally ordered a social work consult.

                  It's really too bad that the social workers in all fields aren't really awesome at helping patients who really need their help.:( Physicians always write an order for social workers to see the patient when a patient is uninsured.......... Too bad they don't write for social work consults just as expediently whenever patients need help from social workers.
                   
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                  Shalom77

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                    Ha, looks like your neck & my neck are similar in these regards. The social workers for medicine & surgery are no where near as effective as the ones for psychiatry.

                    It's really too bad that the social workers in all fields aren't really awesome at helping patients who really need their help.

                    This is actually highly institution dependent. Discharge planning/social work services for surgery was not very good at my med school but fantastic in my residency hospital. (Something to consider when choosing a residency.) I think there were also institutional routines in place that made assessment of these types of patient needs automatic without requiring a written consult from a physician.
                     

                    Faebinder

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                      The mentality of social workers in surgery/medicine vs. psychiatry is soooo different.

                      In surgery, you are not going to get paid for followup complications for 90 days (unless you actually take them to the OR and even now medicare is trying to call those "mistakes"). In medicine, the limit is a week. You wont find as much sympathy from the barely making it practices out there in medicine and surgery. Many times they are handling patients that to put it bluntly, should be left to die. Believe it or not Psychiatry has less morbid patients once they are medicated. They need the help but no way drain as much resources as the gomers in the MICU and SICU.
                       
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