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Archive for October, 2007

Doctors Complain About Complaints

… and I don’t blame (some of ) them.

I’ve seen several articles in the past few days about this topic — that doctors are feeling bashed and unappreciated.

Texas physicians blast anonymous complaints

Closer look irks doctors

Some doctors have their patients complaining on their behalf.

I’m even seeing this about doctors who are overseas — yes — where universal / national healthcare works: Top doc vows to clear name after witch hunt

There is nothing new about doctors getting upset at the fact that patient consumers finally have a public voice (through the internet) that helps vent their frustrations. Nor is it news that doctors don’t like lawsuits when they’ve committed errors. In fact, there used to be a website called www.doctorsknow.us that was established specifically to help doctors blacklist patients who they thought were too difficult. The website was taken down a few years ago, and it’s very interesting to read the comments made by doctors who were supporters.

[And, in fairness, this is not true for all doctors.... nor is it true for all patients. The takeaway here should not be doctors as a whole group -- instead it should be only about those doctors who complain about their patients. ]

So we have patients complaining about doctors, and doctors complaining about patients and everyone complaining about the costs of healthcare, and the dysfunction of the “system.”

Yup – turns out this is another blamers and fixers discussion.

My observation: most complaints are rooted in mismanaged expectations that regard communications and the time/money conundrum.

Do you know of anybody who is happy with healthcare these days? Even if you have a dread disease, and get cured, you’ll complain about the cost, right?

Patients no longer “need” a medical error to get upset. The complaints I hear are that the doctor won’t spend enough time with them, or doesn’t answer all their questions, or always seems in a hurry.

Doctors are frustrated that their patients don’t understand the time constraints they are under, squeezed by health insurance reimbursements that are too low, so the doctor is forced to see more patients each day.

Doctors tell us our outcomes are less than expected because we aren’t complying with their recommended treatments — they complain that it’s often the patient’s fault when treatment doesn’t work because patients aren’t doing as they are told.

Doctors further complain that they are competing with the internet to diagnose and treat patients.

So here is some advice for patients:

Understand that the financial pressures on doctors are beyond anything they have ever been. It used to be they would see, maybe, 20 patients in a day (21 minutes average per patient). That meant they could spend a good deal of time with you to answer your questions. Now, if they want to stay in business (and we need them to!), they must see more like 50 patients in a day (8 minutes per patient) or they won’t have enough income. If they don’t stay in business, we won’t have a doctor to see — and that is already a problem — a shortage of doctors in many areas of medicine. We patients need to adjust our expectations, respecting a doctor’s time constraints.

Knowing you have less time with your doctor, prepare well to see him. Make a concise list of symptoms to report and a concise list of questions to ask. Manage your doctor’s expectations by telling him you have those lists. When he interrupts you (within an average of 18 seconds into your meeting) — then ask him politely not to interrupt. Remember — he’s used to interrupting, so you need to let him know that’s not acceptable.

Do not allow your doctor to provide an instant diagnosis. Make him think outside the box. When he provides you with a diagnosis, ask “what else can it be?” and ask him to explain why it isn’t the alternatives.

Approach your care in a collaborative way. If you have looked up symptoms or diagnoses or treatments on the internet, then warn your doctor that you want to discuss your findings. Manage his expectations that you want to have that discussion but that you are willing to make it a short discussion.

Comply with your co-decided next steps. If you and your doctor agree on what those next steps are going to be, then you have no excuses but to comply. If you run into problems, let your doctor know immediately, otherwise he will think it’s your fault that you aren’t getting better.

Here is some advice for doctors:

Please understand — I GET that you have less time per patient. I GET that your reimbursements squeeze you. I GET that you went to med school and the internet didn’t. I GET that patients are demanding more from you when you have only less time to give. I GET that your practice approach has had to shift with these new realities. I offer this advice to make your lives easier:

You will be less inclined to find problems with your patients if you begin to respect them more. They are sick or hurt. They are scared. They are looking to you for answers and guidance. You are treating them like cattle. You are interrupting them. You aren’t thinking outside the box. And yes, I realize that in fact, if you don’t do it right the first time, you just get paid a second (or third) time for doing it again. But respecting your patients should still come first.

Respect also means it’s time to stop interrupting. I GET that you are interrupting because you know your time is so short — but don’t. If you want to speed things up, then tell your patient that’s what you are doing. “Mr. Jones, please tell me quickly what you learned because I want to spend our time finding the answers for you.”

Understand that the internet is here to stay. It’s not going away. Instead of fighting it, or getting upset with it, why don’t you guide your patients’ use of it? Manage their expectations about YOUR reactions. Provide them with a flyer about the use of the internet that asks them not to bring you stacks of printouts, and guides them to good websites for their use?

When patients don’t get better, don’t automatically assume it’s because they didn’t comply. Yes, I GET that compliance is a big issue — but assuming non-compliance is once again, a respect issue. You can get to that information by asking gentle questions mixed in with symptom or test result questions. By assuming non-compliance, you instantly put your patient on the defensive, and that throws up more roadblocks.

Advice for all:

Next time you are tempted to complain about your doctor, or your patient — ask yourself if the basis stems from communication, or if it stems from time/money constraints. In either case, the “fix” is not the opposite party, the “fix” is your approach. Take a deep breath — then see if you can fix it.

That’s what fixers do. Because complaints and blame don’t get us anywhere.

  ………………
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  ………………

More Evidence for the Positives of Apologies

Those of us who work in patient empowerment couldn’t help but notice the results of a Harvard Medical School study released this week about what happens to a relationship between doctor and patient when the physician makes an error. The story was reported in US News and World Report the New York Times and other outlets.

Originally published in the New England Journal of Medicine (NEJM), the commentary called Guilty, Afraid and Alone: Struggling with Medical Error basically says that when a doctor commits an error against a patient, trust is eroded and doctors feel guilty. (Did anyone question this?)

Turns out that in many cases, the patient’s family members feel guilty, too, for not protecting their loved one. Even nurses who lost family members to medical errors reported feeling isolated, and fearing their loved one was going to receive substandard care due to the guilt of those who had imposed the errors. The words “fear” and “rude” and “mistreatment” polka dot the report.

What’s the bottom line? Once again we hear the benefits of apologies by those who have violated trust. Nothing new here at all. Groups like Sorry Works have been talking about this for years. Thirty-four states have enacted legislation to grease the skids. Those doctors who understand the dynamics, even for their wallets, are beginning to get the picture.

Test it here yourself. Another story published within days in Miami, about a 3-year old who died at the hands of medical test administrators — even though the family questioned the procedure. So very sad. And a good illustration of how we feel on the other end of the tragedy when responsibility is taken by the guilty party. Apologies are plentiful, restitution is being made. By the end of the story, you’ll feel bad for the offenders, too — although not nearly so sympathetic as you do for the family, of course.

Doctors and providers — please pay attention. Your patients truly need you to understand the guilt aspects of errors, and then step up to the plate. Your careers, and our health, depend on it.

  ………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips

Or link here to empower yourself at
EveryPatientsAdvocate.com

  ………………

From the Desk of (10/27/07)…

fromthedeskof.gif

Some miscellany from the week, not requiring entire blog posts of their own….

The fires in Southern California have kept many of us riveted to TV and internet news. As reported earlier this week, my daughter, Becca, lives in Carlsbad, just north and east of several of the fires we’ve followed. I’m relieved and happy to report that she and her sigO Ed were never told to evacuate, and it looks like their home will remain standing, as will their neighbors’. Now they must deal with fallout from the smoky air and the ash that has coated anything and everything.

Thanks to those of you who kept them in your prayers.

……………………………….

My radio show this week features two interviews you might be interested in. Dr. Helen Barkan will discuss migraine headaches, and Dr. Amy Friedman will tell us about kidney and pancreas transplants. My patient tip of the week is “Follow the Money.” If you can’t wait for Sunday, listen to the show from your computer. Same show – no commercials :-)

……………………………….

Have enjoyed my week here in Sarasota, Florida with my patient empowerment students. Our sessions went quite well and as always happens, I learned from my students as well as vice-versa. Thanks to them for that!

I’ve been asked to return to teach again in early in 2008. Let me know if you’re in Sarasota and you’d like dates.

……………………………….

Another great article for CNN’s Empowered Patient this week. Don’t Be a Victim of Pharmacy Errors. Some great tips — including some I’d not thought about before. Take a look. Stay Safe!

……………………………….

For those of you who have followed my column series about Glen and his brain tumor, you’ll want to catch the last in the series this Tuesday. You might be surprised at the outcome — but then again — you might not.

While the series was intended to provide a process for keeping emotions out of medical decision-making, it seems to have stirred a hunger knowledge about Glen’s treatment progress, too.

Stay tuned! And if you want to be among the first to see the last chapter, then sign up for email notification.

……………………………….

Tune in again next week for “From the desk of….” !

  ………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips

Or link here to empower yourself at
EveryPatientsAdvocate.com

  ………………

From the Desk of (10/27/07)…

fromthedeskof.gif

Some miscellany from the week, not requiring entire blog posts of their own….

The fires in Southern California have kept many of us riveted to TV and internet news. As reported earlier this week, my daughter, Becca, lives in Carlsbad, just north and east of several of the fires we’ve followed. I’m relieved and happy to report that she and her sigO Ed were never told to evacuate, and it looks like their home will remain standing, as will their neighbors’. Now they must deal with fallout from the smoky air and the ash that has coated anything and everything.

Thanks to those of you who kept them in your prayers.

……………………………….

My radio show this week features two interviews you might be interested in. Dr. Helen Barkan will discuss migraine headaches, and Dr. Amy Friedman will tell us about kidney and pancreas transplants. My patient tip of the week is “Follow the Money.” If you can’t wait for Sunday, listen to the show from your computer. Same show – no commercials :-)

……………………………….

Have enjoyed my week here in Sarasota, Florida with my patient empowerment students. Our sessions went quite well and as always happens, I learned from my students as well as vice-versa. Thanks to them for that!

I’ve been asked to return to teach again in early in 2008. Let me know if you’re in Sarasota and you’d like dates.

……………………………….

Another great article for CNN’s Empowered Patient this week. Don’t Be a Victim of Pharmacy Errors. Some great tips — including some I’d not thought about before. Take a look. Stay Safe!

……………………………….

For those of you who have followed my column series about Glen and his brain tumor, you’ll want to catch the last in the series this Tuesday. You might be surprised at the outcome — but then again — you might not.

While the series was intended to provide a process for keeping emotions out of medical decision-making, it seems to have stirred a hunger knowledge about Glen’s treatment progress, too.

Stay tuned! And if you want to be among the first to see the last chapter, then sign up for email notification.

……………………………….

Tune in again next week for “From the desk of….” !

  ………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips

Or link here to empower yourself at
EveryPatientsAdvocate.com

  ………………

A Lemon Law for Medical Consumers?

From Hannah Montana to drive-by shootings, there is plenty of interesting news in Cincinnati, Ohio today. But to me, your friendly patient advocate, an even more fascinating topic was reported in Cincinnati’s news this week: the possibility of a lemon law for medical consumers.

To me, it’s one of those “now why didn’t I think of that?” ideas!

A woman named Betsey Exline gets the credit here. Last spring she went for a routine colonoscopy, which was botched, and she ended up with emergency surgery and a stay in the hospital for eight days.

Nine doctors, the emergency surgeons and the hospital then billed her for the insult. Can you say “unmitigated gall?”

Should she sue? She could, although lawsuit cost estimates range into five figures and she’s not getting any younger.

Instead, this very wise woman took a very different approach. Bless her heart, she’s not looking to make money from this error which she will suffer from for the rest of her life. She just wants someone to pay her bills. She just wants someone to recognize that it should not be her responsibility, or her insurance company’s responsibility, to pay for the errors caused by others.

Hello? Duh! That just makes so much sense!

So Betsey contacted her local Ohio state representative and is now pursuing the introduction of legislation that would, in effect, force those who caused the errors to pay for the errors — but not through the courts. Instead the legislation will create a consumer protection process for medical errors. Those who caused the errors will be required to cover the costs that result from their errors.

And if it becomes law? The doctors win because it will cut down on lawsuits. The insurance companies win because it will cut down on lawsuits, too. And the patients win — at least to the extent they won’t have to pay those unfair bills.

(And who will stand in the way? Of course, those lawyers who handle medical error victim lawsuits. but that’s another blog post for another day.)

Wish I was in Cincinnati, Betsey. I’d find you — just to shake your hand. You’re a fixer of the first order.

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Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips

Or link here to empower yourself at
EveryPatientsAdvocate.com

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