Archive for the 'Doctor Communication' Category

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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CNN and Misdiagnosis: Part II

CNN’s Empowered Patient, Elizabeth Cohen, provided more tips this week about what to do if you think you’ve been misdiagnosed.

My own misdiagnosis speaks to four of her five points — and if you have just a seed of a doubt about whether your doctor has diagnosed you correctly, please take Elizabeth’s advice. Here are her points and my experiences:

1. Ask for more tests. The CNN article tells the story of Nancy Keelan whose diagnosis was missed five times until she finally asked for a test her doctor had not ordered. It turns out that after three years of missing the diagnosis, Nancy had endometrial and ovarian cancer.

In my case, two labs had “confirmed” that I had lymphoma based on a biopsy of a lump removed from my torso. Ensuing CT scans and blood tests showed no sign of the lymphoma, yet my doctor insisted I needed chemo. Only by studying my own test results, which were all written in med- and lab-speak which I didn’t understand (meaning I had to look them up), did I realize that another test result was missing. I asked for that test. It turned out to be the pivotal one — the one that proved I had no cancer. If necessary, I also could have asked for a PET scan which would also have revealed I had no cancer.

I need to point out here, too, that I firmly believe that the reason the doctor didn’t look into more tests is because he wanted me to undergo chemo. He is an oncologist. Oncologists make their big money from putting people into treatment. Oncologists are the only medical doctors who profit directly from selling drugs themselves. Read more here.

2. Ask : what else might my illness be? If you have a list of symptoms and you begin reciting them to the doctor, then before you ever get anywhere near the end of the list, the doctor has already figured out what he thinks you have. Never mind that it might be wrong!

From there, he tries to fit what you have into his ideas, not fit his ideas to what you have. It’s backwards.

There is a process doctors use called differential diagnosis. Doctors consider a list of possible diagnoses, then hone in on the right one based on evidence from your symptoms to medical tests. What you want to know is what other possibilities are on that list.

In my case I was diagnosed with a disease called Subcutaneous Panniculitis-like T Cell Lymphoma. The other very obvious possibility was panniculitis — and it turns out that’s what it was. Benign. Goes away on its own. Certainly a better alternative than lymphoma.

But my oncologist was trying to start with the lymphoma and fit my symptoms to it. He asked whether I had hot flashes or night sweats — which I did — which he therefore insisted were signs I had cancer. But hey! I was 52 years old and I’m female. Hello? Geesh.

3. Don’t assume no news is good news. This is so true! Patients tell me frequently that they have been given a medical test, and since they didn’t hear back from the doctor, they assume that means there is no problem. Guess what? Results get lost all the time. The specimen or biopsy may never even make it to the lab for review to begin with. They might never be delivered back to the doctor’s office. They might get lost in the mail or emailed to a spam folder. They might fall to the floor or get filed in the circular file by accident. They might get left in the copy machine, ferheavensake.

Even if they do come back, if they seem unusual, there’s a chance they are wrong anyway! That happened to me.

And, my original biopsy results never came to me until two weeks after the biopsy. I did nag the doctors — but somehow the biopsy had gotten lost in the shuffle because it was the 4th of July holiday. (And don’t even get me started on medicine and the holidays!)

4. Assume your doctors don’t talk to one another. This is way too true. They don’t talk to each other. Period. They don’t WANT to talk to each other. Further, they avoid talking to each other – because — there is no way they can get paid for talking to each other. I do think that Elizabeth’s suggestion that you get them on the same conference call is unrealistic. First of all, most of us don’t have access to the technology. Secondly, because there is no reimbursement code for them to get paid for that kind of conversation, you need to set up a scenario so they WILL talk to each other.

Better to set up an appointments with both at the same time, then show up at one of the offices, and while you are in the doctor’s office with doctor #1, have him place the phone call to doctor #2. After the conversation, get over to doctor #2’s office so he can make a reimbursement claim for you, too. That way they might take the time to talk to each other because they can both get paid for it.

In my case, despite several requests, my oncologists never spoke to each other. Those were the days when I was innocently trying to find my way. Had I known then what I know now? I would have been far more insistent, and an even bigger thorn in the “bad guys” side than I was.

After all — it’s my body and my life, and I’ve simply hired them for their services. If they don’t do it right? Well then — I will do what it takes to make sure it’s right.

And THAT is what I call Patientude.

Thanks for the reminders, CNN.

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Newsweek’s My Turn: What About the Patient?

Last week, Newsweek’s My Turn featured an essay by Dr. Richard Karl. Newsweek called it “Good Doctors Spot Mistakes, Save Lives”… a lousy headline for a well-meaning essay, even if the essay needs a postscript.

(I’ve provided that postscript below.)

Dr. Karl, a surgeon, describes the frustration of trying to track down a sponge which he fears he has left inside his patient. He uses this example to cite one of the many ways physicians, and the medical system in general, harm patients — 15 million of them per year, by count of the Institute of Heathcare Improvement.

He then provides the reasons he thinks this phenomenon has gotten so out of control, from too much innovation to development of too many new drugs and treatment techniques to patients demanding to be a part of their own care decisions.

He’s right. The world has changed.

But the real measure of this man is in his bottom line, where he states, “Most everybody I know in medicine is bright, hardworking and altruistic. Many, though, have been beaten down by hundreds of urgent pages, middle-of-the-night phone calls, decreasing reimbursement, more paperwork and less grateful patients. These doctors have become less careful, and their patients suffer as a result.

It is time for my colleagues and me to reclaim our profession. It is time for doctors and nurses to work together, time for electronic records to actually work in providing the right information to the right person, time for pharmacists and nurses and social workers and doctors to see patients together.”

I hear you Dr. Karl, and I can see that you are trying to shift your thought process from being a blamer to being a fixer. I appreciate that.

But here’s the postscript: in your description of who needs to work together on the “healing together” team, you’ve missed the one person who is, arguably, the most important participant of all: The patient!

Patients: you’ll understand the need to take responsibility by understanding the constraints your providers operate under (as described by Dr. Karl) — it only makes sense for you to be an active participant in your care decisions.

Doctors: if you embrace the empowered, informed patient as a part of the healing team, you’ll find that everyone will benefit. And that, after all, is why you became a doctor.

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All Patients Should be Pro-Choice

Now that I’ve captured your attention, a bit of a disclaimer. I’m not about to blog about Roe vs Wade — no way — not a chance.

Today’s thoughts revolve around patients and their choice of doctors. Or their choice of treatment options. Or their choice of whether they want to choose. Or their choice of making no choice at all, which is a choice.

Whether or not you are good at making choices, it is still your right, or even more so, your responsibility to choose how your decisions will be made, when it comes to determining your healthy future or your medical outcomes.

Patients seem to fall into two camps. Some patients don’t want to have to think for themselves; they just want others to tell them what to do. So they visit convenient doctors, who tell them, “This is what you’ve got. This is the best way to treat it. Go home and do as you’re told, and come back to see me in 10 days to make sure it worked.” And they do. Default.

Other patients — the sharp ones, the ones who are masters of their own universes (thanks Jerry Seinfeld) — understand the patient’s responsibility to choose for himself.

They begin by choosing the right providers based on information they find online, talking to other patients, or the doctor’s reputation (if they can figure it out.)

Then, when they visit the right provider, they engage with him. If the doctor says, “This is what you’ve got,” then the sharp patient says, “What else could it be?” Then he goes home, logs on, looks up all the possibilities, and either concurs with the doctor’s assessment, or begins asking more questions. Together they choose the right diagnosis.

If the doctor says, “This is the best way to treat it,” then the sharp patient asks, “What are the other treatment options? I want to know about them all.” Then the patient considers the pros and cons of each and makes his OWN decision*. Yes, it’s wise to strongly consider the doctor’s recommendations — the doctor is the one with the medical education. But patients should be actively engaged in making their own choice.

If the doctor says, “Go home and do as you’re told and come back to see me in 10 days to make sure it worked,” then the sharp patient says, “Yes, Doctor, I will comply with the treatment — because we worked together to determine the right choice for me.” Then the patient WILL comply — because he knows that’s his best opportunity for healing from whatever problem he has.

The truth is that patients makes choices everyday — some make those choices passively and some make them actively.

Passive choices include: letting someone else tell you what to do, or failure to make a choice at all (which means you have chosen not to make a choice), or agreeing to do what you’ve been prescribed — and then just not doing it. None of these options is a responsible approach.

Active choices include: learning about the various diagnoses that fit your symptoms, then working with your provider to determine which one applies to you, studying the various treatment options available and working with your provider to fit the one that will fit your needs the best, then complying with the treatment regimen, knowing you and your provider determined it together to make sure you achieve your best outcomes.

I’m suggesting that all patients need to actively make choices to find their best outcomes.

Which kind of patient are you? And which patients do you think end up healthier?


*My next newspaper column, which gets emailed to my entire list, is focused on how to make those choices when they become difficult for you. If you’d like to get a copy of my column next Tuesday, Oct. 2, sign up here to receive it.

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Doctors are Blamers or Fixers, too

A week ago, I posted about Blamers and Fixers.

Blamers are those people who have been hurt by our healthcare system in some way, and can’t get beyond the hurt. They are stuck in the anger, frustration and pain. It’s understandable, certainly, especially in cases where some permanent horror has come from it. From the loss of a loved one, to the loss of a body function or limb, it’s understandable, but not particularly helpful, that these folks are stuck in the blaming.

Fixers are about moving on. They, too, have suffered at the hands of the system, many of them in similarly devastating ways, but they have taken their anger, frustration and pain to create something positive for someone else. I listed the people I know who have done such. In some cases, they have lost their children to medical horrors, or they have suffered in some way that would just make your heart break. But they have taken that experience to a platform that creates a better situation for others. It’s cathartic and it’s useful.

I consider myself a Fixer.

Turns out that there are doctors who are Blamers and Fixers, too! I probably shouldn’t have been surprised by that, but I was. Just this week, two articles were shared with me that prove the point.

The first article comes from the Portsmouth Herald — actually published last March — about Dr. Terry Bennett, considered to be a “controversial and opinionated” gentleman titled, Doctor: Greed subverts health care. In the article he takes no prisoners, blasting doctors, facilities and HMOs in particular, then Medicare and Medicaid — in other words — just what you’ve heard me say many times before: American healthcare is not about health or care; it’s about sickness and money.

But the bottom line from the article is this: Dr. Bennett is just a Blamer. Period. He even states that he’s waiting for a “general consumer/voter uprising” to fix the system.

Um. Doctor Bennett…. just what are you doing to help? You are in a good position to be a Fixer. What are you waiting for?

Well — perhaps he is waiting for Dr. Rich Fogoros who has, in fact, analyzed how American healthcare has become so dysfunctional, and has offered his solution. And you know what? It makes a lot of sense!

Just a bit of a disclaimer here — I’ve read Dr. Rich’s book entitled, “Fixing American Healthcare — Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare“. Dr. Rich and I have corresponded on several occasions. I’ve even provided a testimonial for his book. And you can guess why — because he is a Fixer!

The article forwarded to me is a review of the book from Smart Money magazine. It describes Dr. Rich’s theory about the “covert rationing” of healthcare in America — the point that only some people get the care they need and describing the destruction of the doctor-patient relationship. He truly tells it like it is, as ugly as it is. It’s eye opening at the very least.

But the important part is this: Dr. Rich also offers his Grand Unification Theory which describes how to fix it. Yes FIX it. In a fair and acceptable way for all players. Just imagine that!

[If you are one who is interested in the big picture of the healthcare system, if you are curious about how all the disparate pieces of healthcare can come together in a positive way, then you’ll want to read Dr. Rich’s book. A hint: The letter U in his book has nothing to do with Universal and everything to do with Unification.]

Blamers and Fixers…. If a patient is a blamer, OK — it’s understandable. When you have been directly harmed by the system, and absolutely unable to do anything to help make it better, then I can certainly understand why you might be a blamer — at least for awhile. Been there. Done that. And even if you get past the blaming part and just move on, without becoming a fixer — well, I guess I understand that, too.

But I have real trouble digesting doctor-as-blamer and never moving to the fixer position. Just making a lot of noise. Stirring the pot. I don’t see how a doctor has helped one single patient by doing nothing but publicly complaining. Whine whine whine.

It’s like voting. It drives me nuts to hear people complain about this politician or that one, or this issue or that one — when the complainer doesn’t even get off his duff to vote. Whine whine whine.

So Dr. Bennett — please stop whining and step up to the plate. Read Dr. Rich Fogoros’ book. See what you think. Then step up to become a Fixer.

That’s my guantlet. I’m throwing it down.


By the way: John Stossel is taking on the challenge of suggesting a fix to the system tonite on 20/20 on ABC-TV. I’ll blog about that in the next few days. [I’m looking for some creative ideas, John!]

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Docs: It’s OK to Say You Don’t Know

I’m spending a few days visiting my parents in Florida and brought along Dr. Jerome Groopman’s book, How Doctors Think.

This is my second reading of this incredibly eye opening and wonderfully useful book. I’m a major fan.

This time I’m actually highlighting and post-it noting and starring and turning down page corners. It will probably take me forever to get through it. To give you an impression of how much important material I’m finding, I’m already on my third color of post-it tabs. And I’ve taken seven pages of notes.

On occasion I’m going to bring you some of Dr. Groopman’s gems. So here is the first one:

In the book, Dr. Groopman tells the story of problems with his hand and getting a diagnosis. He had to visit four doctors before he had a diagnosis that made sense to him. When you remember that he is a physician (a hematologist) then having to see so many doctors for a diagnosis that made sense is remarkable.

Without giving away all the reasons why (because that would be like giving you the good stuff from the book!) I will share his reaction at one of the doctors who wanted to surgically explore the structure of Dr. Groopman’s hand. When Dr. G asked what that doctor thought was the problem, the doctor replied that he wasn’t sure.

And Dr. G stated he was oddly reassured that the doctor would admit he didn’t know. Why? Because he had already been to one doctor who made up a name for a diagnosis that didn’t really exist.

Can you imagine that? A doctor making up a name for a diagnosis that didn’t really exist? Further, can you imagine the gall of a doctor who would make up a false diagnosis for another doctor’s condition? Yikes.

But it brings to mind many emails I’ve received from people asking me to help them find information about diagnoses so they can read more about them. There have been a handful of times they have given me a name I couldn’t find either. I’ve asked them to double check spellings or to ask the doctor to write the name for them. Sometimes all we could do was isolate the body system because most of the time those names are a body part paired with some exotic-sounding adjective.

Maybe those doctors were making up diagnosis labels too?

It’s human nature to want a label, and it’s human nature to want to know all the answers. I believe some doctors make up names to satisfy both those needs — they want to give an answer to someone who craves a label. They want to be heroes, and they don’t want their patients to think they don’t know. As patients, we believe that once we have the label, we’ll have the cure.

However, I can’t think for one minute that any of that is helpful? How can it be helpful for a doctor to make up something fictitious? And how does a made-up label improve someone’s health?

And what are the possibilities that in concocting a label, a diagnosis will be missed?

So here are two pieces of advice I’ve developed from How Doctors Think.

For doctors: when you help us, THEN you will be our heroes. Making something up just to have a name doesn’t help you treat us, nor does it help us heal. Please be straight with us. If a diagnosis eludes you, tell us you don’t know, but you’ll work with us to figure it out. That way we can partner to find the right answers.

For patients: if you suspect your doctor isn’t talking bona fide medicine, call him on it! If you are frustrated by the inability to find a diagnosis, don’t grasp at a label just to have a name. Work toward honing in on the correct body system, then the correct body part if you can, then descriptions of what is causing problems with that body part or system. There are so many reasons why you may not be able to get just one name for your medical problems. Don’t complicate the determination by insisting on a label that’s not accurate.

P.S.  A note to Dr. Groopman:  when I write to you to ask you for your autograph, I’ll buy a new copy to send  🙂

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Drs Abr Can Mk U Sckr

An article in US News and World Report quantifies the number of deaths and injuries that result from doctors’ handwriting and the abbreviations they use on prescriptions.

Reassuringly, those errors cause only a small percentage of the 7,000 American deaths attributed to medication errors each year. It turns out that there are thousands of those kinds of errors, but most get caught by a nurse, pharmacist or someone else. (Maybe even a patient!)

I also found it interesting to learn that the Joint Commission has a list of prescription abbreviations they think doctors should avoid. Here’s a link.

Two thoughts come to mind. First, that this is exactly what I was talking about when I wrote this column, published a few weeks ago:

Your Prescriptions: Cracking the Code

And second, that these kinds of errors are 100% preventable — and WE, the patients, can prevent them by double checking everything on the prescription handed to us. Ask the prescribing doctor to provide you with verbal instructions to double check the written prescription. AND, ask the pharmacist to provide you with verbal instructions, double check them against what the doctor told you and wrote for you, AND double check them against the written instructions provided to you when you pick up the prescription.

It’s one error that can be easily checked and stopped by patients. So, let’s do it!

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