Put yourself in the shoes of a nursing home resident [PODCAST]

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“Visit a nursing home and talk with some of the residents. They are not only moms and dads, but also retired teachers, first responders, former athletes, government employees, and soldiers—the basis of our country’s past lives within these walls.

Older adults should be honored with the dignity they deserve.

As we again open as a society after this pandemic, make that commitment and visit a nursing home.

Just make sure after you enter, the door doesn’t lock behind you.”

Gene Uzawa Dorio is an internal medicine physician who blogs at SCV Physician Report.

He shares his story and discusses his KevinMD article, “The nursing home crucible.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Gene Dorio. He’s an internal medicine physician, and he wrote the KevinMD article “The nursing home crucible.” Gene, welcome to the show.

Gene Uzawa Dorio: Kevin, thank you so much for having this platform, this podcast. I just think it’s tremendous, but thank you for getting me on board.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Gene Uzawa Dorio: You know, I was born in New York, but we came to California, where I grew up. I went to school in Mexico. So for some who cross the border into California, I crossed the border and went to Mexico, and I had to learn a new culture, a new language, and study in a different language. But I was fortunate; I was able to get a great education there. Some of it, though, was back up here in the United States, my third and fourth years, so I was mostly in Southern California.

Once I graduated, I went to Baylor to do surgery, but because I’m a foreign graduate, even though I’m an American, I had to do a Fifth Pathway. I don’t know if they still have that now, but I had to do that for one year, and at the University of Maryland, so I got experience there. I went into a rotating internship at Wayne State, doing trauma as well, but I ended up getting into the program here in Southern California at UC Irvine and Long Beach Veterans. I was there for three years and then worked one year outside, and beyond that, but then I opened my own practice in Santa Clarita, which is north of Los Angeles. So I’ve been here for about 34, almost 35 years practicing, and I’ve been a doctor for over 40 years now.

So I looked back at some of your podcasts, and I think I’m just about the oldest person that you’ve had on the show. Not that that’s saying much, because age is irrelevant as long as you are practicing good medicine, of course. But it brought me to a state here and a city here where I was able to practice as a private practitioner for all these years, and I’ve enjoyed that.

I got into writing probably around 20 years ago, just as a little hobby, but it was good enough to have postings and publishing in many different places. So I decided I needed to be an advocate, because at that point, 25, 30 years ago, things were starting to change in medicine. Some of it was really good, technology-wise, but some of it, especially the business part, you know, Kevin, was difficult for all of us to handle, and it has subsequently come on to this arena right now that we are facing. So I thank you for allowing all of us to have this platform to be able to discuss these issues that are out there that the American people face in trying to get good health care.

Kevin Pho: As a private practice physician, as you know, that’s a growing minority when it comes to physician jobs. So tell me, with your decades of experience in private practice, what would you say are some of the biggest challenges that you face?

Gene Uzawa Dorio: Oh, there is no doubt, Kevin: It’s the bureaucracy that has evolved with the insurance companies, with the government, the regulations that are there. Hey, I’m all for practicing good medicine, but when it came to that paperwork and trying to get care for individuals, and then subsequently realizing that some of that, Kevin, was because other people wanted to make money, and they were making money off our license to practice. If they were making money and putting it back into the system, I’m fine, but when they’re making money and putting it into their pocket, I’m not fine, and that’s what’s been going on. That’s been the biggest challenge, I think, for those who have gone into practice like myself.

Now, you know that private practice, and even a solo practice, is not a wide arena now. It used to be you go through your residency program, and boom, you’re into a practice somewhere, with a group or solo, and I went solo. But to continue doing that and achieving that, the big thing that I found, at least being a private practitioner, an asset, was that I was able to continue making good medical decisions for my patients, not based on their insurance, not based on the money that they have, but based on what their needs are. Those are important to me, and I think important for all of us, but I have the flexibility still to be able to practice in a way that benefits my patients.

Kevin Pho: All right, so let’s transition into the KevinMD article that you wrote. It’s titled “The nursing home crucible.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Gene Uzawa Dorio: Well, you know, most of my patients are geriatric. When I first came to Santa Clarita, I was already doing house calls, and I continue to do house calls to this day. It’s probably 99 percent of my practice, going to people’s homes. So I knew that once patients were hospitalized, there are deficits in trying to take care of people at home. I realized that trying to get lab tests, trying to get X-rays, trying to do ultrasounds, trying to get nursing care and physical therapists, occupational therapists, all those, I was having trouble doing. And I knew and realized that some of them would end up in nursing homes, which they did.

So in writing the article, I wanted to make sure that people understood the mentality of being in a nursing home. I wanted to put their shoes in that nursing home, so they would understand what especially our seniors and disabled are facing. That wasn’t quite out there. I mean, there have been anecdotal stories by individuals, but I wanted to give it from a doctor’s perspective, of someone going to nursing homes for almost 35 years. My understanding and recognition of the problems that they would face in nursing homes was gigantic, and so I wanted the public to see that, one.

Secondly, I wanted to point out how we can keep people in their own homes in the best way possible, and what we need to do to move forward. And thirdly, I wanted to point out the problems related to trying to get people into a thought process of how to improve the nursing homes that exist right now. So it was threefold, my attempts to get that understanding out there. I tried my best to put out an article that would encompass all of that without tearing things apart and trying to build it back up. That’s a difficult thing to do. I wanted to put it to the patients, the caregivers, and the nurses and physicians who take care of patients, and try to avoid nursing homes if possible.

Kevin Pho: Now, can you paint us a picture or tell us a story of something that you would like my audience to know about nursing homes from your perspective?

Gene Uzawa Dorio: The main thing is, Kevin, they’re human beings. They’re not just numbers. They’re family members, they’re moms, they’re dads. They’ve done things in society and contributed in the armed forces and industry and business, and as doctors, even. These are human beings, and I want people to understand you’re not just taking a person who needs to heal from a hospital and needs to find a place to heal. You’re putting them into a place where they have to find a comfort zone. And that comfort zone, you know, Kevin, I will tell you, I was there the day before yesterday doing my nursing home rounds, and the majority of individuals are not at all in their comfort zone when they’re in a nursing home.

We have to make it available. How we do that isn’t going to cost more money, I think. As I looked at the numbers and the calculations myself, I think it’s for having people at home, in their own home, and taking care of them there, as opposed to putting them in nursing homes. But the thought process is, let’s go the easy route and slide them down into a nursing home, and to me, that’s not humane. We have to change this thought process of how, as we get older, we’re going to live life.

The biggest fear, I will tell you, Kevin: Not one of my patients, ever, in 40 years, not one has ever said, “Dr. Dorio, please send me to a nursing home.” Not one. And so I know that we can do better. I know we can do it financially better, and especially health care-wise better. So that’s the whole objective of what I was trying to do, and to get that message across to the medical students, to the residents, also to the hospitals and those who are pushing patients and sliding them into a nursing home situation where it’s not good for them nor healthy for them.

Kevin Pho: Now, can you go into a little more detail about some of the challenges that nursing homes across the country face?

Gene Uzawa Dorio: Nursing homes face tremendous challenges financially. How do you survive in a business that doesn’t get support by government, doesn’t reimburse you well? And then you have to cut the corners, and nobody benefits from that. The patients themselves lose. When you don’t have a library, when you don’t have a computer room, when you don’t have a kitchen, when you don’t have things that people had at their home, you’re in trouble. So it’s a challenge for these nursing homes to survive. And then there are some business people who have taken advantage of the nursing homes and have yanked out all the profits for themselves, which is really sad.

Kevin Pho: Do we need to regulate nursing homes?

Gene Uzawa Dorio: Well, I think if physicians played a greater role in understanding the dynamics of nursing homes, nursing homes would do better. But unfortunately, most people don’t understand it, and I think we have to move from this lack of understanding, utilizing it only as a place to put people, not even to get rehab or get better. We have to start thinking, how are we going to use that for society and make it a safety net for those individuals who need it? If we don’t have that support from government, from industry, from business people, and from society, all of us are going to be, in the long run, in trouble.

Kevin Pho: Now, what’s the path forward? Is it simply a matter of funding?

Gene Uzawa Dorio: I think it’s attitude. I think that certainly funding can play a role, but by my simple calculations (I’m not an accountant or a CPA or a government person), I think there is a path to this. We just have to figure out how we’re going to do it and start putting in the numbers and seeing how they add up. I look at the waste that we have in terms of what we’re doing already in nursing homes and how we’re doing it, how we’re doing it with hospitals as well. There are ways to smooth this out and make this better, but it takes a concerted effort. It takes an awareness from people in government who are making these laws, so we have to start engaging them and talking to them, and not for ourselves, not through medical organizations, but for the people, to say, “We’re doing this on behalf of older adults in our country.” When we take this awareness and put it in the forefront, I think we’ll have a better advantage and ability to be able to make the changes that we need.

But I think 25 years from now, Kevin, it’s going to be totally different. I think somebody is going to say, “Hey, this is what needed to be done, and we did it.” But right now, we’re in that learning curve, trying to figure out how we are going to do this, and it’s going to take a lot of us to be able to put our minds into it.

Kevin Pho: We’re talking to Gene Dorio. He’s an internal medicine physician, and he wrote the KevinMD article “The nursing home crucible.” Gene, like you, I’m an internal medicine primary care physician. Is there anything that physicians like us can do in the exam room, in an outpatient center setting, to prevent people from going to nursing homes? Because, as you mentioned earlier, the best place to care for patients is at their homes.

Gene Uzawa Dorio: Absolutely. And I honestly think our listeners, our medical students, really should consider the possibility of doing house calls. They really need to see how individuals live. They need to understand what they’re up against. I saw a patient yesterday who had abdominal pain, couldn’t stand up and walk, and he wanted to get to the office, but he couldn’t. So I went and did a house call and assessed him, and something, I think, is going on. I don’t know what it is, but he would never have been able to make it to the doctor’s office and would have had to utilize the emergency room, which costs much more money, and he was trying to avoid that. So my presence as a house call doctor made a difference.

I have that expertise in doing house calls for all these years, but I think that needs to come back now. I think you are very independent; you make your medical decisions. The only thing we don’t have with house calls is the tools, all the tools here. I’ve demanded that we get dental work, and I’ve had a dentist actually do a house call. I had an orthopedist go and see a patient, without doing an X-ray, to do an exam to determine whether it was the hip or the knee. I mean, we have to start doing this and saying, “This is what needs to be done.” I’m reimbursing those doctors who want to do it, but to me, it’s a great location other than just the office.

When I first opened my practice, I devoted one day to house calls, and then it became two days, then it became three days. And unfortunately, those who were disabled and those who were immobile started to mount up, and it’s still mounting up with this generation now, not just the Greatest Generation, but now the baby boom generation. They’re multiplying very quickly. House calls and independence in practice are key. So if anybody’s interested, for free, I will give them advice on how they can do house calls to better their community and better the people, and prevent them, in the long run, from being admitted to the hospital. So we can do this; we just have to have the right attitude. I know there are countries around the world where doctors are doing house calls. We have to look at them, look at what some doctors like myself have done in house calls, and bring that back into the vote, to decrease hospitalizations, improve the care, and get people back on their feet to have quality of life.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Gene Uzawa Dorio: You know, I think it’s never give up. We are facing a clear-cut change in medicine and an attitude that’s out there. There’s an onslaught of insurance companies and government making medical decisions for us, when we’re the educated ones. So I say don’t worry, because in the long run, you will make the right decisions. The question will have to be, will you get frustrated by somebody else usurping your opinion and moving it in a different direction? But I say don’t give up on that, because there are ways.

And I tell you, I’ve learned because of the writing: When I’ve been denied, like, a procedure, I’ve taken it into my writing and been able to change a person’s mind through the correct background of educating that person, or sometimes, hate to say it, also saying, “Legally, you’re irresponsible.” So there are tools and ideas and ways of being able to move everything in the right direction. But we’re all going to run into that frustration, Kevin, in our practice. I say don’t give up. Keep fighting back. And if all of us do it, and with your platform, like you’re doing now, giving ideas to everybody else on how we can utilize the system better for our patients.

Kevin Pho: Gene, thank you so much for sharing your time and insight. Thanks again for being on the show.

Gene Uzawa Dorio: You’re very welcome, Kevin. Thank you so much. Appreciate it.

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