It seems to me that as the local health networks continue to expand their footprint as they naturally do with growth, that accountability for their actions often seems to be forgotten. It is often replaced with the platitudes similar to “I’m not sure why that happened to you” as opposed to actually investigating a situation to determine where the system failed and preventing it from happening again. 

Here is just one such example that is still an ongoing saga to which I devoted about 40 minutes on the phone again today trying to get to the bottom of it and was basically told that while it made no sense that these things happened, there’s nothing they can do to prevent it in the future. This is entirely unacceptable and as patients or more bluntly as consumers, we deserve better. It’s time we find a way to work together and open the lines of communication between providers and patients to increase accountability and awareness of issues when they arise, as they often will, because no health system or business, for that matter, are perfect or infallible. 

So last Thursday I was to have a follow-up appointment with a specialist’s office and see an advanced practitioner that day instead of the doctor. I’ve encountered some phenomenal advanced practitioners over the years so had no problem with that. My issue was that the Tuesday or Wednesday prior to my appointment I got a telephone call late in the afternoon informing me that my labwork was too old to be useful and that I needed to go get more blood drawn that night in order to keep my appointment, otherwise they would cancel it and I would have to reschedule. 

There was no way I could go get the labs redrawn on such short notice and as such they cancelled my appointment and told me they would call me back to reschedule it but that they had put the orders in the computer system so all I had to do was go to any network facility to have the required labs drawn. Sounds simple enough, right? 

Friday morning after physical therapy at one of their facilities I go to get the labs drawn. I register at the front desk for the x-rays I needed for another specialist, but am informed that there are no orders for bloodwork in the system from the specialist’s office. I had other obligations and no time to wait to try to sort it out with the physician’s office at that moment, but I did call their office a few hours later that same day.  

I was informed that my version of events was absolutely accurate and that my chart showed the same documentation as the items I’ve described above and that in fact someone had not put the orders in the system. There was some confusion, it seemed, as to why I needed new labwork performed, who decided this, and what precisely they wanted repeated as this aspect of things was not documented in my chart. Once again I was told they would look into it and get back to me. 

Fast forward to Tuesday (Monday was a holiday) and I received a voicemail from a female who I believe stated she was a physician, though not one of my normal physicians, stating she got my message and that the labs I had done a couple of months ago were fine, but that I failed to show up for my follow-up appointment and I must call her immediately. 

I call the number she left in the voicemail and nobody in that office seems to have a clue as to what is going on, what I’m talking about, or why someone other than my physician or his advanced practitioner would call me. After being disconnected three times, waiting on hold for what I believe was about 10 minutes, I was no closer to sorting out this mystery and worse yet I was losing time from a project sitting on the phone with them. 

Eventually, I got transferred to another office and after speaking with and being transferred to three more people I finally got someone who seemed to comprehend what I was saying and agreed that things made no sense. She apologized but asked if she could put me on hold to talk to her colleague and a nurse about this and try to get to the bottom of it. She came back on the phone about two or three minutes later and informed me that I should not have been told any of that prior.  

My labs were suitable for the follow-up and she has no clue who authorized that order or to cancel my original appointment last week. She proceeded to offer me times to come in for the appointment tomorrow, Wednesday, but this means me taking even more time away from other obligations in order to do so and this will be the third day I’ve lost time trying to accomplish what could have just been done in one day as it had originally been ordered. 

Unfortunately, when I inquired as to what they could do to prevent this from happening again to someone else I was informed that they can’t prevent it because they don’t know how or why it happened in the first place. While they may not be cognizant of how or why it happened, you would think they would care enough to investigate it or at the very least put procedures in place so it can’t happen again so easily. 

I realize healthcare is a business and speaking realistically if customers were treated with such disregard for their major part in the business of healthcare in nearly any other business environment, there would be outrage, boycotts of that business entity, and eventually they would likely go bankrupt and close because they did not provide value to their clientele. Yet, in healthcare, all too often it is simply accepted as the norm and that there’s nothing we can do about it. 

We as patients, and yes even consumers of healthcare, have got to find a way to work with providers in order to open effective communication and impress upon the healthcare field that we deserve the same respect that providers demand. If patients are more than 5 to 15 minutes late for an appointment they are rescheduled and sometimes even charged a no-show fee for failing to cancel more than 24 hours prior to their scheduled appointment. 

Yet physician’s offices routinely run more than 15 minutes behind and sometimes hours behind and we have no recourse and are forced to accept it as normal. I took time out of my schedule three separate days to sort out an issue that by their own admission never should have even happened. Now I have to take time out of my schedule for a fourth day to go to the appointment that never should have been canceled in the first place. 

Patients and providers need to find a way to communicate effectively and together to improve the healthcare system so that we can all have a better understanding of what each other experiences and how we can try to improve the system as a whole, without playing the blame game. I don’t blame anyone in particular for the experience I’ve shared above. I blame an ever fragmented and siloed system of healthcare in which patients have little to no voice and it is not uncommon for the physician to never even be made aware of a problem because there are so many layers between them and the patients. 

What are your thoughts on how we can work together to improve healthcare? 

Answers Aren’t Always Easy to Find

So today I come home from my second overnight sleep study in three weeks with more questions than answers. To say I am frustrated, confused, and even a bit defeated would all be accurate. This may seem confusing when you read why below, but I promise to make sense of it. It’s important to keep in mind that medicine is rarely simple and especially for those of us with multiple or complex medical conditions it gets increasingly complicated.

Continue reading “Answers Aren’t Always Easy to Find”

A Note to Providers About Professionalism

Professionalism goes a very long way in patient relationships. Even if you don’t feel compassion, sympathy or empathy for your patients the fact that healthcare is a business and good business requires good customer service, I strongly suggest you learn how to at least fake it and fake it well. Openly doodling and blatantly leaving it for your patient to find does not instill a sense of professionalism a provider should hope for.

Continue reading “A Note to Providers About Professionalism”

Time to Talk – #AtoZChallenge2018

Time is a finite thing when it comes to our lives regardless of whether we are healthy or ill. None of us know how long we will have on this planet before our time is up. This is a fact. Also a fact is that while many of us do not wish to talk about it we really need to be having the difficult discussions with our family about what we )and they) may desire should either become unable to make or communicate decisions regarding their medical care on their own. Continue reading “Time to Talk – #AtoZChallenge2018”

Zebras #AtoZChallenge

Zebras     #AtoZChallenge

There is nothing more frustrating as a patient than having a provider look at you and summarily discount your symptoms as ‘impossible’. It is very common that we are hesitant, even afraid, of that which we do not understand. It is also true that those trained to diagnose and treat us could and should be held to a higher standard.

It is to them we look when our body revolts against us in ways which we do not understand. It is them to whom we turn when we feel our body couldn’t possibly be destroying itself as it seems to be doing. It is our physicians we look to for an answer of that which we cannot make sense of on our own. And that is how it should be for they are the ones with years and years of education and experience upon which to base their examination and diagnosis.

However, when learning the science of medical care, they are often taught to think of the most common diagnosis first. While on the surface this makes sense, oftentimes they fail to diligently pursue our entire history and symptoms in order to make a proper diagnosis. As with anything in life one must take into account all pertinent information in order to make a proper determination as to what is happening.

A phrase often used early in one’s practice of treating other human beings is “when you think hoofbeats think horses, not zebras.” While this may work in the majority of cases, I assure you that it does not work well in every scenario, nor should it be expected to. A better way to phrase this lesson would be “when horses no longer make sense, start thinking zebras”.

Frequently when a physician actually takes the time to perform a full and complete exam and history they are left at a loss as to precisely what the cause may be in their more complex population of patients. That is because those of us with complex medical problems do not present as the typical patient. Our symptoms may not even make sense presenting with each other. Nevertheless, we are very real and so are our symptoms. We deserve to be believed and to have our complaints and symptoms taken seriously regardless of whether they make immediate sense or not.

Both when working in patient care, and while being a patient, I have encountered too many stories of people suffering for years prior to receiving a true and accurate diagnosis. While it is true that sometimes a proper diagnosis eludes medical science, it is also true that sometimes when a diagnosis isn’t readily recognizable, we as patients suffer. Sometimes we suffer needlessly when just a little perseverance on the part of our medical professionals would provide an answer. Other times a diagnosis just isn’t possible.

My suggestion to medical professionals is to be willing to consider zebras when horses no longer make sound medical judgment. Don’t be unwilling to consider the obscure. Be more than willing to advocate for and on behalf of your patients right to proper diagnosis and treatment. Above all else, do no harm. For when you dismiss us, you are often causing irreparable harm physically, medically, and emotionally.

Do you have a story you’d like to share regarding a challenge in obtaining a proper diagnosis or treatment? Please share with us in the comments below.

Inpatient Mental Health Just As Important As Physical Health

Most often when we think of someone being in the hospital, we think instantly of their physical health. However, mental health can play an important role in healing physical issues as well. The mental health aspect of healthcare, when it comes to physical maladies is often overlooked, or simply not thought of as often as it should be. I am a firm believer that every patient who has been admitted to the hospital should receive, at the very least, a cursory mental health examination. By doing so, properly trained staff may well be able to predict the need for further psychological or even psychiatric interventions.

This cursory exam should be performed on each and every patient who is admitted to the hospital, to identify potential concerns. This should apply even if the patient is entering the hospital for a seemingly simple procedure or even something that may be as considered as routine as giving birth. Whether the patient is a veteran like myself, with maybe a new and unfamiliar medical condition, or a relatively healthy person who has experienced a life-altering medical or trauma related incident that has led them to the hospital. Either of these patients can experience many forms of anxiety which can manifest itself as anger towards others including staff, and by the untrained professional caregiver be considered as non-compliant or even belligerent, when all they truly are is scared and anxious of the unknown.

I have personally once been prematurely discharged from the hospital by what I deem to be an improperly trained resident who had convinced his attending that I was being belligerent and argumentative. In reality I was suffering the well documented effects some people experience from steroid medications, nicknamed “roid rage” in the medical community. It is so aptly named because the patient becomes argumentative, belligerent, and occasionally even physically violent on steroid medications. While I partially blame this on inadequate training of the resident managing my case. I further blame it on inadequate oversight and supervision of the resident by his direct superior who signed off on my discharge without ascertaining all the facts for themselves.

By having and properly utilizing mental health services, you can prevent unnecessary “labels” such as non-compliant and belligerent from being applied to patients which carry their own risk of further using or heightening anxiety. By making the appropriate mental health referrals, you can not only reduce the stress a patient may encounter, but improve their physical recovery as it has been well documented over time that mental health can most definitely affect physical health in a variety of ways. Emotional distress can manifest itself into physical symptoms which in turn could easily complicate proper diagnosis and treatment of a patient, especially if the providers have not considered the patients mental and emotional health appropriately.

To someone with a major or even relatively minor illness that requires hospitalization, and this is their first ever encounter with the inpatient aspect of healthcare, the experience can be quite stressful. The issues one may feel range from depression over the source of their admission, especially if it will be a long term illness or recovery, to loss of control over their own life and care, to anger (why did this happen to me), feelings of loss, or any range of emotions. It is important to realize that the first time patient, has absolutely no idea what to expect when admitted to the hospital. And realistically, most often staff themselves are too busy to explain each step of the way what the new patient may expect.

Even a veteran patient like myself, can find themselves feeling similar anxieties despite being sometimes intimately familiar with what to expect. Maybe the reason for this admission is different than precious ones, or you have a different physician with whom you do not have your normal rapport. Or maybe you are simply anxious over the unknowns of being hospitalized despite having been through it before. Maybe you are facing a potentially lengthy recovery that will require admission to a physical rehabilitation facility or even to a skilled nursing facility, often referred to as nursing homes. While skilled nursing facilities are often also utilized for short and sometimes even long term physical rehabilitation, the stigma associated with the term “nursing home” may well cause further anxiety, and yes even fear in a patient. These items need to be addressed before they further complicate the patient’s recovery.

Not only is it perfectly okay to feel this way, but it is also entirely normal for some people to be more susceptible to the stressors of being hospitalized in an inpatient setting. This does not imply weakness of either mind or body, rather it indicates that you are reacting normally to a stressful situation of which you have little to no control, or even any idea what will happen next. One in which it is often not explained to you on an ongoing and consistent basis what is going on with your care.

More than once, I’ve had a transport aide arrive at my room to inform me that they are there to take me for <insert random medical test here>, when I had no clue that such a test had been ordered, let alone even considered to be necessary by my medical team. Sadly this has become the norm. Patients in ICU often experience even more severe anxiety than those on a regular floor. Between the severity of their particular health condition, the unfamiliar surroundings, the and the unusually naturally stressful environment of the ICU itself, are all stressors to even the most experienced patients, as I myself can attest to having recently awakened on a ventilator when that was not expected in the least.

I’m not saying every patient who gets admitted to the hospital should be placed on anti-depressants or other mental health medications or treatments. What I am advocating, is that everyone involved in the patient care team pay attention for the warning signs of some of the aforementioned stressors that can also contribute to depression on a more long term basis if not addressed properly in the first place. Often an outburst by an otherwise very pleasant patient is a sign of something lurking below the surface such as anxiety, or even confusion over their healthcare.

As previously stated, a routine mental health screening wouldn’t be a bad idea to determine those patients who may be more susceptible to the above issues, or even those who may already be experiencing them, but are afraid to admit it for fear of feeling or being labeled as crazy. Mental health should be a part of every patients care management team, for both their own health as well as staff safety. If you have a patient who is feeling overwhelmed who may lash out, this then become an important safety issue for not only the patient but also facility staff.

During a recently particularly stressful day, and a relatively sleepless night due to that stress, despite being totally unrelated to my hospital admission, I was in a really sensitive and even downright bad and cranky mood. An innocent comment made to me by a staff member that I took out of context, led me to verbally lash out at this staff member. Thankfully this staff member was very familiar with me and new that this was way out of context of my normal demeanor. Rather than simply lash out in return to my outburst, she took the time to speak with me, and determine the real cause of my demeanor change. When all was said and done, things ended on a relatively positive and upbeat note. The particular staff member realized that right then was not the time to “push” me into the scheduled treatment, and graciously agreed to give me time to collect my thoughts and myself, in order to better face the day ahead. Further she agreed to make accommodations in her very hectic schedule to permit me to make up that treatment.

In closing, if you or a loved one finds yourself as an inpatient, be sure to be aware of the potential stressors that could further aggravate your health and your recovery. Don’t be afraid to reach out for an evaluation, or treatment if necessary. It is not an admission of weakness. Quite the contrary it is an admission of strength enough to know your body well enough to know it’s own limits, and to know when to ask for help!