Posts Tagged 'Trust'

When Dirty Doctors Can’t Be Identified

As promised in yesterday’s post, I’m reporting today on a frustration among those of us who work in patient safety.

That frustration is once again sparked in this report from the Hartford Courant. Fifteen year old Mark Tsvok, injured in an auto accident in 2004, died from his injuries as a result of the misdeeds of Dr. Daniel H. Hechtman who made one misstep after the next in his treatment (or lack thereof) of the teenager.

After a series of investigations and hearings, Dr. Hechtman lost his license to practice anywhere in the state of Connecticut.

So what did he do?

Find the rest of this post at its new location:

http://www.trishatorrey.com/2007/10/17/when-dirty-doctors-cant-be-identified/

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Doctor Hunt: Practicing What I Preach

I’m proud of my husband and the reason holds a good lesson for us all….

Over the past six months or so, our experiences with our family doctor’s practice have been less than acceptable. First, Hubby contacted their “prescription refill hotline” about three weeks before his arthritis prescription ran out. He needed a new prescription and knew it would take some time to get it….but…. two weeks later he had to call them again. Then the next day, then the next. He was told they had called in his prescription to our pharmacy but — no — the pharmacy had no record. Eventually, because he had run out and was in pain, he stood at the pharmacy counter while they called the doctor’s office. Not right.

Turns out that part of the problem was that his doctor had left the practice! Of course, no one bothered mentioning that, nor had they bothered to tell him he had been “reassigned” to a new doctor — a 30-something woman who I’m sure is a fine doctor — but not for my 50-something husband who would prefer a male doctor!

Hubby is not a happy camper.

I ran into my own problems. I go for an annual checkup each fall. I made my appointment a couple months ago and was told to go in a week or so ahead for a blood draw. OK. I asked whether I needed to fast for the blood draw. Nope, I was told. That’s not necessary.

So, Monday, I called the doctor’s office to make sure all the paperwork had been done so I could go to the lab for the blood draw on Tuesday. “It sure is,” I was told, “They are a part of our system, so they have all your paperwork in the computer.” I asked again — are you sure I don’t need to fast? No — no need.

So I headed to the lab about 3 PM Tuesday. You guessed it. Yes, they found my records — but — the labwork request had been cancelled. Huh? Long story short — not only did I have to go back to the doctor’s office to straighten it out, but it turns out that yes, I did need to fast for the blood draw!

My doctor happened to walk into the reception area of the office while I was there. She asked why I was there (knowing, I guess, that I had no appointment) — and I told her I was there to straighten out the blood work fiasco. I asked her– fast or no fast? “Of course you have to fast, unless you want to be unhappy with the results!” she replied flippantly as she turned around and marched out of the room.

OK — so now I’ve gone from annoyance to ticked-off.

So these are two VERY BASIC services that require no rocket science whatsoever to handle. If they can’t do any better than this with the basics, how can we be sure they will handle anything of any consequence correctly?

So Hubby and I decided together we would begin to look for a new practice to move to — and yesterday Hubby began checking with our insurer to see who else is on their list of providers.

He narrowed his search down to a half dozen doctors — and then — he started researching them. He didn’t ask me for advice, instead, he just started poking around the internet. Sure enough, he found information that one of the doctors on his list has been fined $2,500 for some kind of squirrely billing practices. (I translate that as the possibility of Medicare Fraud — but I don’t know that for sure.)

Our next steps are to begin asking others whether they know any of these doctors to see if we can find happy patients. We’re not really in any hurry — thankfully — because we are both healthy and we’ve had all the 50-something tests we’re supposed to have, etc.

I’ll keep you posted on the great doctor hunt. Just wanted you to know that it can be done, and will be done.

Gotta let you know that yes — in our home — we practice what I preach.

Paging Marcus Welby!

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Prayers for Tom

Last month I told you about my email pal Tom who battled with his health insurance company to get permission to go to the Cleveland Clinic for specialized surgery that he can’t get at home. I told you at the time that with each “win” for the possibility of his heart surgery, the insurance company would throw another hurdle in his way.

Tom WON. He stuck it out, using respectful but persistent steps and tactics, and ultimately — yes — he got approval for his surgery at the Cleveland Clinic….

…. which will take place tomorrow morning. Tomorrow, Wednesday, September 19.

If Tom and I bumped into each other on the street, I wouldn’t know him. We are “just” email pals.  But our discussions have all been about this life saving surgery he needs and fought for. I feel a kinship, and find myself thinking about his surgery tomorrow, and knowing all the efforts he has invested in it, knowing that it is heart surgery and there’s a chance — always a chance they’ll run into trouble….

So as the rest of us go about our daily business tomorrow, my prayers will be with Tom and his surgeons. I hope if you are so inclined, you’ll put in a good word with Whomever you put those good words to, too.

When Tom can get to email, he’ll let us know how he made out. Please note: I said WHEN, and not if.

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Human Microchips? Told You So!

A few months ago I blogged about the push by the manufacturers of RFID chips, radio frequency identification computer chips, to begin implanting them in humans. At the time, I was pretty definite about the cons of the subject. I recommended against the idea in — ahem — the strongest of terms.

A report by the Associated Press (click here to access links to 90 different news outlets) states that in fact, the manufacturer, VeriChip, and the FDA may have ignored studies that linked use of the chips to higher incidents of cancer in pets and mice.

Cancer! So they aren’t just a lousy security risk, they cause cancer, too.

I’ll keep my chips on the poker table or in a snack bag, thank you very much.

Thanks to my security guru, Bob, for the heads up….

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Monster, Marshalls, Others Prove No Privacy

Your no-brainer quiz for today:  What do Monster.com, Visa, Marshalls and TJMax, Oklahoma Law Enforcement, Spotsylvania County, PA, and at least 500 other entities have in common?

They have lost electronic information to hackers, scammers and phishers in the past three years.

And there’s a good chance some of YOUR personal information was among the records they lost.

Think about it:  your credit card numbers, your social security number, your bank account information….  somebody else has it now because these entities couldn’t keep track of it.

So why do I write about this today?

News in many newspapers and across the internet tells about the latest big loss — Monster.com which acknowledged losses earlier this month.  Read about it in Forbes.

And it brings to mind an email conversation with my new internet privacy guru, Bob Hedin, who warns in a very pointed way that there is no such thing as secure information. Period.

And how is this important to patients? 

Because every large internet entity out there is trying to get YOU to manage your health at its website.  They want you to keep EMRs, Electronic Medical Records.  The idea is that you and your doctor (eventually) will be able to keep your health records online.  Everything from your family history, to your doctor visits, medical test results, x-rays and CT scans, shot records, the drugs you take — everything.  How convenient it will be to have access to them from anywhere in the world!

Even the New York Times weighs in.

Sounds great, right?  Easy access?

Not so fast!  There are HUGE privacy and security problems here… because despite anything they may claim about keeping your information private, it just plain cannot be done.  Period.

Who are these large internet players?  Here’s a starting list.  It will grow, I’m sure:

  • MSN
  • Google
  • WebMD
  • Revolution Health
  • …. to name a few.

Why do you think they are interested?  Out of the kindness of their hearts?  Not a chance.  When you realize that in order to provide this service to you it will cost them out of their pockets for the storage space and administration….  they aren’t going to provide it for free.  Nor do they want to.

Nope.  Instead, they will use it for advertising!  So when you pull up your records, and recorded there is the fact that you have arthritis, which ads will you see in your “free’ medical record?  Drugs for arthritis, of course!  And how do THEY know you have arthritis?  Yes.  Because their ‘bots have “read” your records.  And if their ‘bots can do it, so can anyone else.

And who’s to say they won’t sell your information, too?  Pharmacies do it — every day they sell lists of the people who buy their drugs to the manufacturers and others who want the information.  So why shouldn’t internet companies do the same?

Honestly.  Some people just won’t care how private their records are.  Well, that is, until they get turned down for something important to them — like a new job, or life insurance, or even health insurance — eventually a home loan because they were diagnosed with breast cancer a few years ago, or even a car loan because they were treated after someone else hit THEM last year. And the only way to get much of that info is to gain access to health records that have been kept online. 

Sounds kind of Big Brotherish, doesn’t it?  Not to mention a motherlode for MSN, Google, and the others?

Now — I’ve blogged before about the importance of keeping one’s records.  And I even think there is a great halfway point.  Keep track of your own records electronically on a travel drive (thumb drive, jump drive — one of the little ones you can attach to your keychain.)  Then, at least, you can keep them with you wherever — and even if you lose it, it will be backed up on your hard drive on your computer at home (which, of course, you have security software installed).  And if someone finds the travel drive, what will they do with it anyway? 

OK.  It’s not a perfect system — but it’s better than putting all your information out there with one of the internet giants to be sold to the highest bidder.

Want to read more?  Here are a few previous posts:

Pay Cash for your Healthcare

Medical Family History: Get it Down Before They’re Gone

Steve Case’s Revolution Raises Privacy Questions

And as for Monster.com?  I’d be sweating bullets right now if my boss didn’t know I had my resume online, looking for a new job. 

Hate it when those security breaches happen.

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Blink, Intuition, Gut Reaction: Spot On

I don’t write often on trusting one’s intuition for making health care decisions.  I should do it more often.  Here’s why:

A few years ago I read Malcolm Gladwell’s Blink — an analysis of how we use our unconscious, our intuition, and how accurate it turns out to be.  At the time I remember feeling almost vindicated — which I’ll explain more about in a minute.

Cited in Blink was a German social psychologist, Dr. Gerd Gigerenzer, who has done studies on intuitive thinking on ordinary people like you and me.  I found an article in this morning’s New York Times about a book Dr. Gigerenzer has now written called, Gut Feelings: The Intelligence of the Unconscious.

In his book, Dr. Gigerenzer offers a basis for gut feelings — those made-in-a-flash decisions or judgments we make based on…. what?  Often we don’t know.  Dr. Gigerenzer suggests gut instincts are based on cues in our environment, and our ability to subconciously recognize them comes from heuristics which are built in, evolutionary abilities in the human brain. In most situations, when people use their instincts, they are heeding these cues and ignoring other unnecessary information.

So what’s the question here? 

We all experience instinct and intuitive feelings, but our society doesn’t seem to value them as decision-making tools. Dr. Gigerenzer cites Benjamin Franklin’s account of rational decisionmaking — weighing written lists of pros and cons as an example of that devaluation.

Personally, I think there are two other reasons.  First — I think we are all too interested in covering our backsides.  We live in a litigious society, one that needs paperwork and evidence to prove every decision is right.  Robbed a bank?  You can’t be convicted without the evidence, even if everyone “knows” you did it.  Need a mortgage?  The mortgage broker won’t give you a mortgage based on instinct;  he’ll need all the paperwork to back him up.  Think your golf has improved?  You’ll have to pull all your scorecards together and make a chart to see if your handicap is lower than it used to be.

But more important than stockpiling evidence is the question of trusting our intuition.  We may have those flashes of ideas, but do we trust them?  It’s the question of trust that made me feel vindicated when I read Blink.

Like most of us, I grew up making those rational decisions that require lists of pros and cons.  In particular, I remember trying to decide what college to go to.  On paper, one of them seemed better than the other, but in my heart (or, based on intution) I wanted to to Bucknell University.  I went with my gut instinct and the decision turned out to be the right one for me.

More important to this discussion however, was the way I used — then TRUSTED — my intuition when it came to my cancer diagnosis.  I just KNEW the pathology reports were wrong.  I just KNEW I didn’t have cancer.  And I set out to prove it.  And I was right

Had I not trusted my intuition, I would have undergone chemo.  One can only imagine what the fallout would have been from unnecessary chemo.

There is no downside to trusting one’s intuition about one’s health, as long as that intuition takes you in wise directions.  For example, “knowing” that you don’t have enough information to make a decision will send you in the direction of researching further, getting a second opinion, asking relevant questions, or finding support from other patients.  “Knowing” you are experiencing side effects that are dangerous, as opposed to accepting them because you think they are just part of taking that drug, will send you back to the doctor’s office to review whether you are taking the right drug, or taking it in the right dose.

The only time trusting your intuition about your health can be bad is if you mix it up with wishful thinking.  “Knowing” you don’t need to see a doctor because that pain that’s shooting down your arm can’t possibly be a heart attack…. or “knowing” that your dizziness and drooping mouth can’t possibly be a stroke — that’s not trusting your intuition — that’s wishful thinking and it may cost you your life.

Trusting one’s intuition to get the best care possible is a real, bonafide, patient tool.  Use it.  Use it wisely.  You’ll be healthier because of it.

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Doctors: Apologize for Euphemistic Unanticipated Outcomes

Doctors at the University of Illinois Chicago Medical Center are being encouraged to admit medical mistakes and apologize to their patients, so states an article by Judith Graham, published in this week’s Chicago Tribune.

Good! And I can’t state that strongly enough.

I’ll add, it’s about time, so what took so long, and one down — what about the other 6,499 hospitals in the US?  (OK, a few encourage apologies — see below.)

Ms. Graham did an excellent job with the article.  She presents the many aspects of the history of physician apologies, why doctors have, or haven’t, apologized over time, and provides very substantive quotes from various experts in the field.  In effect, egos and fear of retribution in the form of lawsuits have stood between physician mistakes and patient communication over time. 

No surprise there.

A few points stand out from the story — worthy of being shared.  First, that the Veterans Administration and hospitals affiliated with Harvard Medical School encourage their staffs to tell patients about errors, provide an apology — and (very importantly) explain what they will do in the future to prevent a similar mistake.  As someone who has been burned by a medical error, I can very much appreciate that approach.  I may have suffered, but I can feel a bit better about it if I know they will take steps to be sure it doesn’t happen again.

Second, that the Joint Commission on Accreditation of Healthcare Organizations (the group that oversees the credentials of hospitals, formerly called JCAHO) also encourages fessing up.  That’s good, too.

But in the midst of the Joint Commission’s recommendation, they have also developed a new euphemism for medical errors.  Honestly — this is so ridiculous, it made me laugh out loud!  God forbid we should call a medical error spade a spade — they now call them “unanticipated outcomes.” 

What a cop out!  Medical mistakes are not “unanticipated” outcomes at all!   Mistakes are just that — mistakes.  If a doctor makes an incision in the wrong place, there is nothing unanticipated about it — it’s just a mistake.  If a doctor prescribes the wrong drug or the wrong dose of the right drug, there is nothing unanticipated about it — it was just plain wrong.  If a doctor misdiagnoses or orders the wrong treatment — it’s an error, plain and simple. If a doctor doesn’t stop to wash his hands, and his patient acquires an infection — c’mon – it’s not at all “unanticipated!”

And – when any provider makes a mistake, s/he can most certainly anticipate the outcome!  S/he can anticipate that it will cause a problem for the patient.  S/he can anticipate that the patient will take longer to heal — or might even die!  S/he can anticipate that the patient and his/her family will be upset.  And on and on.

OK — you’re right.  Nobody plans to make a mistake.  But that doesn’t mean the mistake was unanticipated.  No way.  So — Joint Commission — why don’t you call a medical error exactly what it is?  It’s a medical error!

All this reminds me of that book that came out about 20 years ago about everything I needed to know I learned in kindergarten.  My parents (and kindergarten teacher) taught me to be honest, to come clean about mistakes and above all, to apologize to the person I wronged.  I wasn’t allowed to use my fear of punishment as an excuse, and certainly I was never allowed to let my ego get in the way…. not a chance….

So, doctors — you have absolutely no reason to cover your backsides by non-communication and lack of apologies any longer.  Big name organizations are providing this message — no matter what they call a mistake or — excuse me — an unanticipated outcome — apologize and communicate! 

Patient trust is already tentative at best.  Non-communication is no longer acceptable, regardless of whether it’s your ego or your insurance company whispering in your ear.   Stop making excuses, stop covering up, stop pretending the consequences of your errors were “unanticipated.” 

Be human. Be apologetic. Be humble. Be available.  You’ll sleep better, too.

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Note:  see follow up post:  Did My Doctors Apologize?

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Doctor’s Office Scam: More Info

I have but a few minutes today to provide more info, compliments of Bob, who I mentioned yesterday…. 

Bob alerted us to this scenario:  going in for a check up, he was asked to return the next day for a blood test.  When he returned the next day, he was charged another co-pay (and of course, the office will bill insurance again.)  Thing is — there is no reason the test could not have been done the first day — the day he was there for a checkup!  It was not a fasting blood test (meaning he would have to refrain from eating anything for many hours before hand…)

I wrote back to Bob and asked him why he thought it was a scam (thinking perhaps there was a reason he had to be there a second day?  argh.  sometimes I can be so naive!)…. Here is Bob’s reply:

I confronted the doctor because the day I returned, they did NOT do a fasting blood sugar — only a HA1C.  As an informed diabetic, I know that a Hemoglobin A1C measures over time the results of the hA1c represent average blood sugar for the previous 2-3 months). 

There was absolutely no legitimate medical reason to schedule blood work the following day.  All the other tests were routine and not time sensitive.  I use a PHR (personal health record) and get copies of ALL documents – including labs – and can prove every statement I’ve made here.

I no longer will use that doctor.  However, I have reason to believe this scam is taught by management consultants as a sure fire revenue builder. 

Recycle 10 patients a day for blood work tomorrow.  Do that five days a week with 4.3 weeks in the month and it is NOT small change.  Do the math on a $25.00 co-pay like mine if you want to see the dollars. 10 * 5 * 4.3 * $25.00…  That tidy sum makes the payments on a very nice car.”

And my note — the doctor gets the co-pay AND bills insurance again….. ha!

This is an excellent heads up for those of us watching our health care dollars (who doesn’t?)  And I can only imagine a few other ways this is happening, too.  Any tests or procedures that can be handled in your doctor’s office — but put off for another day so they can charge again and again.

If your doctor suggests one of these tests or procedures for another day, or even suggests you simply return for no apparent reason, then ask — no — insist — the test or procedure take place before you leave.  If they say it can’t be done, tell them you’ll be happy to return, but you aren’t willing to cough up another co-pay.

Explained a different way — your mechanic charges a basic fee for working on your car, no matter what gets done to it — in addition to the work that gets done to it.  You take your car in for repair, and he only does part of the job — and insists you bring your car back tomorrow for the rest — and charges you that basic fee again.  Would you stand for that?

Don’t stand for this scam either….  and if there seems to be no way around it, you might want to do what Bob did — find another doctor.

Thanks for the heads up, Bob.  We’ve got enough problems with healthcare these days without having to worry about being robbed by our providers, too!

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More Trust Violations

Some misc pieces for a chilly Tuesday morning in the Northeast (at least we don’t have a hurricane coming through!)….

I heard from Bob, a reader who alerted us all to a scam-of-sorts — meant to increase revenue for the doctor while draining a patient’s pocket for no apparent reason….  it’s unclear from his email whether it happened to him — but — here’s the takeaway:

 You go to the doctor for a check-up.  At the end of the exam, you are scheduled for bloodwork and told to return the next day.  So — now you have to make a second trip AND pay a second co-pay.  Why?  Why can’t they draw the blood while you are there?

Granted — it could be a fasting blood-sugar test — which should be explained to you.  But if it was a check up, then they knew that’s why you were there to begin with, and it should have taken place just prior to your exam, fasting the night before — right?

Bob’s point is a good one, in two ways:  first, don’t let them schedule you for a return visit, which you’ll need to pay for, unless it’s absolutely necessary. Ask if whatever they need to do then can’t be done while you are already there.   And second, when you make an apopintment for a check up, ask whether you should fast beforehand, if that would help move the process along.

Good points, Bob.  Thanks.

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Then I heard from a woman who blogs under the pseudonym of N=1 about healthcare politics, policies, trends, and all those big picture things that mostly get in the way of healthcare.  You know — my statement that American healthcare is not about health or care –> it’s about sickness and money.  It seems she was part of the healthcare landscape, in a highly responsible position, for many many years — and blew the whistle and got fired — and is now persona-non-grata when it comes to being hired elsewhere. 

Talk about a trust violation!  The very person who sticks her stake in the ground to HELP is now left out of the helping field all together. 

She’s taken her skills, anger and vision to her blog and other writing.  While I don’t agree with everything she writes, I admire her chutzpah to go out on such a long limb….   And the points she makes are certainly based on our lack of trust for “the system” that is so out of control.

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I really hate not trusting.  Just want to make that clear.  It’s not in my nature.  Last week in a conversation with an advocate I was “meeting” for the first time (who I’ll blog about in a day or two — some really good stuff!) I explained to her that the ONLY part of this work I do that I dislike is that edge of cynicism I have had to develop.  It’s just not who I’ve been in my entire life.  In fact, I’ve been dubbed Pollyanna too many times! That gives you some idea of how far outside my comfort level this new edge is for me.

But I also know it’s necessary to fulfill my mission of helping patients help themselves.  Asking the right questions at the right time, looking at the inside from the outside,  trying to play devil’s advocate — it’s all worth it if the result is a better outcome for just one person.

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Trust Can Get You into Medical Trouble

Several contacts and occurrences of late have reminded me of how trust without verification can get us into medical trouble.

My first BIG reminder — more like a wake-up call — comes from my invitation to those on my email list to join me at the Pharmaceutical Marketing Conference in Philadelphia in September.  I asked for people with stories to share about their experiences with pharma companies to send me some basic information.  The goal is to find a cross-section of opinions to share with the pharma industry.

I was jolted right out of my desk chair at the responses — the majority of which come from people who trusted their doctors to provide them with a drug to help them, only to learn that they are either now addicted, or someone they love has attempted suicide (and sadly, two were successful.)  They trusted the doctor, they trusted the drug, and they are paying the price.

(Reminds me — if you have a story to share — please let me know!  You can write to me at:  blog@diagKNOWsis.org )

My next reminder comes from a gentleman who is scheduled for surgery in September.  Like Max, who I blogged about months ago, Jim was told he needed his prostate removed and had no idea he had more than one option for that kind of surgery.  He trusted the surgeon he visited who told him he needed laprascopic removal, only to find out there were other options.  Now he no longer trusts the surgeon because he feels like information was kept from him.  He has changed surgeons.

Then I heard from Doris, who read my post last week about retaliation.  She has been undiagnosed for months, having been told she has everything from an autoimmune disorder, to chronic fatigue, to rheumatoid arthritis, and now they are testing her for MS.  She thinks now that her doctor is just running tests to shut her up — and feels like it’s HIS form of retaliation.  She no longer trusts that he is making recommendations in her best interest.

How frightening that so many have lost so much trust in their healthcare providers, and the system in general.  And yet, it’s absolutely no surprise to me.  The system is set up for everyone to fail (except, of course, the insurance companies and the pharm companies — another story for another day….)

Which only makes it that much more imperative that we take an active role in the research and decision making aspects of our own care. 

Begin at the doctor’s office as you are being diagnosed and s/he is providing treatment recommendations.  Always ask, “What else could it be?”  “What other treatments are available.”  “Are you sure you are telling me everything that is possible?”

Then double check it all.  Look online, look up the words you don’t understand, study the drugs you’ve been prescribed, find other patients with the same diagnosis and ask them about their experiences. 

And if you learn that your doctor gave it to you straight?  Then — and only then — can you form a trusting bond with him/her.  Although you’ll want to continue verification with each visit.

And if you find out some of the information was lacking?  Then go back to that doctor and ask about the missing pieces.   His/her reaction will tell you what you need to do next. You may find out there were good reasons (f’rinstance — you don’t fit the profile for a different treatment).  Or you may find out that you need to find another doctor.

Don’t trust blindly just because someone has an M.D. or O.D. after his or her name. 

“Trust but Verify” should be the rule for your medical care.

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