Read Patient Stories (cont.)
Although I have had some great experiences with my physicians, this one bad experience really shattered my trust. I have Long QT Syndrome and require an AICD (Automated Implantable Cardioverter Defibrillator) to help me recover from episodes of ventricular tachycardia. The AICD needs regular checks to ensure proper functioning.
During one such check-up, some serious concerns were raised about whether the leads (wires) were functioning properly. It was decided that I would undergo surgery to replace the leads and also replace the AICD due to its shortening battery life.
The doctor told me all the things he was planning to do in regards to the surgery during our last visit in the office. That was about a week before the surgery.
The pre-authorization for the surgery was done by the doctor's office. I did talk to my insurance company just to make sure all things we approved and authorized. I was told I was "all set." I did not think to ask specifically if the new AICD implant was included.
I signed a consent form but I really didn't read it, "Just please
sign this, it okays that we can do the surgery." I signed without
reading. This happened just before wheeling me into the OR. Won't do
that mistake again, I hope.
After surgery, the doctor informed me that only the leads were replaced.
The old AICD was adapted to new leads and NOT replaced. I did NOT agree
to that as part of my surgery. The doctor said my insurance declined
his request for a new AICD, but I was not informed of this prior to
surgery. I was given no chance to fight the insurance company's denial.
Thus just a few short months later I had to undergo another surgery
to replace the old AICD due to poor battery life. My AICD was implanted
under abdominal muscle to conceal it so surgery required several recovery
days, not to mention stress.
I immediately left his office/practice as a patient after this episode. I sent a letter to the Board of Directors. I did get a reply from them saying they were sorry, the doctor was acting in my best interest, etc. and that no legal claim could be made because there were no injuries to report. His actions severed my trust in doctors for a long time.
My second physician had no problem getting consent for the second surgery.
My AICD clearly needed changing due to low battery life and met the
requirements. He also up-graded me to a much better device without adapted
leads (which are inferior). The 2nd physician also told me he frequently
gets denied the first time he files with the insurance company in these
types of cases, but he writes the necessary letters to get approval
by the insurance companies to get the best for his patients. He was
appalled at the old Dr's actions.
The old doctor should never have changed the details of the surgery
without informing me, the patient. Conflicts with the insurance companies
need to be addressed before the surgery date. Letters/phone calls need
to be made. The loss of trust was quite traumatic. Having a AICD means
depending on doctors, insurance companies to do the right thing. Always!
MYDOCTORSTORY LESSON FOR PATIENTS:
This story happens far too frequently. The person who submitted this
story did an outstanding job of sticking up for herself and finding
a new doctor to help her. Do not assume that your insurance is taken
care of just because they say 'all set.' Double-check that pre-certification
included all contingencies before you book your surgery and explain
to your doctors about your priorities and concerns. Finally, make sure
you read Informed Consent forms (even if they tell you that you don't
have to).
MYDOCTORSTORY LESSON FOR HEALTHCARE PROFESSIONALS: When patients lose trust, you lose your opportunity to really help them. You don't need us to tell you what went wrong here. Share this story with your team and remind them of the critical importance of being detail-oriented and taking nothing for granted in your communications with patients
My mother, an 81-yr old Alzheimer's patient was rushed to the ER -
the third time in three months. She was then sent on to the ICU, again.
I called the ICU nurse to check on my mother's condition and was told
that my mother was not breathing on her own and she could die at any
time. I asked if I should come right over to the hospital, a 2-hour
drive. She said to call back in one hour to speak with the other nurse.
When I called back, the 2nd nurse said that because my mother was on
a ventilator the machine was breathing for her. My mother was stable
and there was no reason for me to rush over and that I should come to
visit the next day as I had planned.
When I arrived the next day, the MD asked if I had a DNR order for my
mother. He said there was no hope for my mother and that she should
not be resuscitated given her age and the Alzheimer's. I did not know
what a DNR was. I said that we had a living will but that I would check
on the DNR.
He walked away from me muttering, "These stupid adult children
that do not follow the parent's wishes are fools." The nurse concurred.
I said to both of them, "I am still here and I can hear you!"
After all of that, my mother was discharged from the hospital and went
home breathing on her own.
MYDOCTORSTORY LESSON FOR PATIENTS: A "DNR" (Do Not
Resuscitate) order is a binding legal document that informs healthcare
professionals not to use 'extraordinary measures' to prolong a patient's
life in the event of cardiac or respiratory distress. If you are caring
for a loved one, it's important to know about this.
Second, ICU personnel are specially trained professionals who excel
in caring for people who are in deep trouble. They pay a price for consistently
working in high pressure situations and too often their stress comes
out in rude and inappropriate behaviors. This is not said to excuse
it, only to provide understanding so that you can dismiss their behaviors
rather than take them personally. It is perfectly ok to hold people
accountable and request that you be treated with respect. Keep in mind,
that works both ways.
If you want better service in ICU, learn to speak their language - speak
quickly, provide only critical data, and don't get in their way. Don't
expect them to make decisions for you about whether you should come
to the hospital. Simply ask for data and then make up your own mind
from that. Keep in mind that every moment they spend talking to you
is a moment that keeps them from giving full attention to your loved
one.
MYDOCTORSTORY LESSON FOR HEALTHCARE PROFESSIONALS: Consider assigning
a patient advocate to handle family calls so that you can be free to
focus on your patients. Attention administrators: if your doctors and
staff are displaying this kind of behavior, something is going on that
needs to be fixed. People only display negativity when they are angry
about something. Find out what it is and help them to resolve the problem
or the negativity will spread like a bad virus.
My daughter's allergist went to great lengths to give my 18 year-old
the causes of her fruit allergies. He "watered" down the clinical
discussion to the details of what mattered to a teenager and his use
of succinct language (rather than jargon) appealed to her. It went a
long way with her compliance with her regimen and her interest in seeing
him on a regular basis.
MYDOCTORSTORY LESSON FOR PATIENTS: If
you don't understand what a doctor is telling you, it is really okay
to ask. There's no shame in that. Doctors get in a habit of speaking
in clinical terms and they just need to be reminded to speak in lay-language.
Simply say "Would you please translate that into 6-year-old kid
words?"
MYDOCTORSTORY LESSON FOR HEALTHCARE PROFESSIONALS:
If your words aren't understood, your patient won't comply. If you can't
translate your words into 6-year-old kid language, the odds are that
you don't really understand it. Encourage all of your staff to practice
this technique. It will take you a long way towards building trust and
patient compliance.
I was a new graduate from physical therapy; ready to 'save' the world.
I was hired by a company that, from my naïve perspective, was leading
Connecticut in a new direction of clinical excellence, professionalism
and efficiency; I was proud.
My intention was to be the best; provide the most expedient, appropriate
care in the field of physical therapy. I was networking with local physicians
and rapidly developing a name as the go-to guy for their families and
friends. Things were working out well, very well.
This was in early days of 'managed health care'. I was young, naïve
and very motivated to be the best. I wanted to help those suffering
to attain wellness in the most efficient fashion possible. I wanted
to do my best- and I accomplished my goals. I was able to get those
suffering well, quickly.
The reputation of being an honest, hard-working, thinking clinician
grew weekly. For each patient that I was able to help, they referred
three others. My schedule was booked for weeks at end when the owner
of the company called me to his office; it was "urgent"; I
was excited.
I opened the door to the owner's office. He sat at the desk with thin
lips. He commented on my performance; his tone was flat. He remarked
that 'on average' I had been getting the patients better in six visits
while they, 'on average', were authorized for twelve visits.
I was very proud of this accomplishment. I was doing well - and they
were keeping track! I was being noticed.
"Don't you think that you can do less each visit so that we don't
'waste' the other six authorized visits?
With a touch of shock and awe, I replied that "no, I can't do this.
"
"Then you can't work for me."
Editor's note: This physical therapist now owns his own practice
and keeps patients in treatment as long only as long as they need it.
Sometimes that means he keeps them way beyond average and gets penalized
by the insurance companies. As a result, his tier is way low and he
works 14-hour days to care for his family. This is the choice he has
made.
MYDOCTORSTORY LESSON FOR PATIENTS:
This is a tough one. The simple truth is that physical therapists (and
all healthcare professionals) are incentivized to do less. In other
words, the less they do, the more they get paid. This is because insurance
companies rank doctors on a 'tier' system: the better their record for
getting patients out the door, the higher their ranking and the greater
percentage of reimbursement they receive. Many healthcare professionals
are opting out of taking insurance just for this reason.
If you want to know all your options, ask your healthcare professional
one question, "If money and insurance were no object, what would
you recommend?"
MYDOCTORSTORY LESSON FOR HEALTHCARE PROFESSIONALS:
You are entitled to set limits regarding the work you are willing to
do for the reimbursement you receive, however we will never fix the
problems in our system unless everyone is made aware of them.
Consider providing your patients with information about all of their
choices, with full disclosure regarding the realities of insurance reimbursement.
I visited a new dermatologist and I never returned. Here's what happened.
When I arrived for my appointment, two staff members (behind the glass
screen in the reception area) were speaking very loudly about the poor
working conditions in the practice. They were within earshot of everyone
in the waiting room but it didn't matter to them. They were complaining
about another person in the practice, I guessed the office manager who
was also one of the physician's wives! They couldn't get the time off
they wanted and they were fed up doing her work. Really bad form. And
then I saw the doctor whose wife they were discussing. He seemed a decent
enough clinician but I knew more about him and his practice than I wanted
to!
MYDOCTORSTORY LESSON FOR PATIENTS: When
you walk into a medical or dental practice, pay close attention to the
staff members. If they are unhappy, there is a strong chance that your
care will be lacking. Staff plays a huge role in follow-through - from
clinical orders for testing to making sure your insurance is managed.
The same is true for doctors. If the doctors aren't getting what they
need, their distraction can ultimately impact you. Trust your instincts.
If it's not a happy, safe and organized environment, find one that is.
MYDOCTORSTORY LESSON FOR HEALTHCARE PROFESSIONALS: Never underestimate
the power of an aligned team. If your doctors and staff aren't functioning
effectively, you will lose market share and, more importantly, be at
high risks for clinical and financial errors. If you invest in nothing
else this year, build a strong team and make sure that you are all aligned
to a common action plan.
I'm a patient in a 3-woman ob/gyn practice. With my last baby, I called
the practice when I started labor to see which physician was on-call.
There was one doctor I really liked -- and I hoped that she was on call
that night. Unfortunately it was not my favorite doctor but one of the
other partners, a very good clinician and trained at one of the top
programs in the country.
I knew that I would be going to the hospital later that evening (second
baby so I knew what was coming) and so I alerted the answering service.
In the middle of the night I went to the hospital but it was apparent
very quickly that the staff was unable to reach my physician, the doctor
on call. The nurses seemed agitated and rushed and my husband started
to worry, as did I, that my doctor would not make it to the hospital
on time.
Another hour later I was pushing and the attending physician -- a doctor
who knew nothing of me or my history -- ended up delivering my baby.
The baby was healthy and my ob/gyn showed up 1 hour after the birth.
So what happened? My ob/gyn was tired and left the message with the
office to phone her at home as she was going to go to bed. She left
her pager on the kitchen table and so she never heard it going off.
The answering service initially never called her on her home number
-- they never had that instruction. They just paged her and paged her.
Finally, they did reach her but only after the baby was born.
She was flustered and embarrassed when she got to the hospital. She
blamed the incident on the "office staff." We were all very
lucky that the birth was easy and my baby girl was healthy. But what
kind of communication was in that practice? And why did the doctor blame
it on the staff? Shouldn't she have kept her pager by her bed?
MYDOCTORSTORY LESSON FOR PATIENTS: Do
not assume that communications between your doctor and staff are perfect
(more often than not, there are huge gaps in communication in healthcare
practices). Double check that your doctors and their staff members are
coordinated for your care by asking specific questions like, "Do
you know how to reach the doctor in case the answering service messes
up?" Also, in case of emergency it's a good idea to keep a copy
of your personal health records with you just in case. Consider uploading
a file to your smart phone.
MYDOCTORSTORY LESSON FOR HEALTHCARE PROFESSIONALS:
Blaming others for your lack of service? Really? How is that lack of
accountability any different then what we've seen in the banking industry?
If your staff isn't well trained and ready for anything, fix the problem.
In the meantime, if something goes wrong, remember that apologies and
personal accountability go a long way towards maintaining a strong relationship
with your patients.
Come Back to Read More Doctor Stories Soon!