Archive for the 'Doctor Communication' Category

A Dose of Reality – Today’s Doctor Appointment

Please note that this column first appeared in the Syracuse Post Standard
October 11, 2011

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In the “old” days, we could phone for a primary care doctor’s appointment in the morning, be seen right away, spend enough time with the doctor, leave with a treatment plan, and usually feel better within a day or two.

But no longer! Today it’s difficult to get an appointment, even within a few days. We sit in waiting rooms far longer than we expect. Then when we finally see the doctor, we often feel like we’re being rushed out the door.

We patients tend to blame our doctors and the way they run their practices. Why should we have to wait so long? Why won’t they spend more time with us?  What’s the big hurry?

The truth is, your doctor doesn’t like today’s limited time system either.  He would love nothing more than to be able to make immediate appointments, see you the moment you arrive in his office, and spend plenty of time with you, too.  But the insurance reimbursement system doesn’t make that possible.

Last week I had the opportunity to work with personnel at North and Northeast Medical Centers.  I was asked to help them help us patients manage this time-constrained reality we are all stuck with to improve patient satisfaction. I suggested some steps they can take to help their patients get the most from their appointments.

But the patient-provider relationship is two sided. We patients need to take our responsibilities in that relationship more seriously, too.

We can do so by preparing ahead of our appointments:

First – Write down anything that is new since your last appointment. New symptoms, new aches or pains, new supplements you’re talking, drugs another doctor has prescribed, or new triggers you’ve discovered that create problems for you. Record them along with the dates they started.

Second – Take a list of every drug and supplement you take, including brand names and dosages.  Note any that will need renewal within the next 90 days.  Or, instead of listing them, throw the containers into a bag and take them with you.

Third – Write down your questions. Prioritize them since you’ll only have time to ask two or three.  If you have more than one medical problem, and therefore extra questions, then make an additional appointment.

Being a prepared patient will make every interface with your doctor more effective and efficient. You’ll be more likely to get what you need – a collaboration that’s beneficial to you and your doctor.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

 Effective Patient-Doctor Communications

Why Do I Wait So Long for my Doctor Appointment?

Are You Prepared for Your Doctor Appointment?

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An Open Letter to Hospitals

Please note that this column appeared in the Syracuse Post Standard on September 13, 2011.  It addresses the recently issued New York State Hospital Report Card.  You don’t need to be a resident of Central New York, or even New York State to gain benefit from this column.  Resources for you are found below.

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Dear Central New York Hospitals:

It’s report card time.  That time when we patients get the opportunity to learn whether or not you’ve improved your patient care and outcomes since last year.

I was hoping to find glowing reports. After all, you know exactly what will be measured and what needs to be done to earn the highest grades.  No one’s expecting miracles; just safe and timely care, a clean environment, pain management and effective communications.

But did I find stellar reports?  No.

Granted, the report card says I have less of a chance of catching pneumonia at St. Joes.  And, Community General, congratulations on your infection rate which is lower than the average hospital in New York State.  Both St. Elizabeth’s and Faxton in Utica are doing quite well avoiding Pulmonary Embolisms and Deep Vein Thromboses.

But those are only three high grades among almost four dozen measurements.  My real concerns are for those that registered lower than statewide averages – so low that some patients are dying, acquiring infections, suffering pain, and leaving your facility in worse condition than when they were admitted.  Each one of you earned the lowest possible score in at least three categories.

According to news reports, one official blamed bad scores on outdated statistics. Sorry – that’s no excuse! Your patients are human beings, not statistics.  Perhaps their pain, debilitation or death took place a few years ago, but many of those patients are still in pain, still debilitated and yes, still dead today.

As you know, beginning next year, Medicare will take patient satisfaction survey scores into account when it comes to determining reimbursements. We patients don’t require much to score you highly on those surveys.  We expect only the basics: communicate with us respectfully, prevent infections, avoid mistakes, keep us as pain-free as possible, and send us home with instructions we understand and can carry out.

Put another way:  treat us the way you would treat your own loved ones. Provide for us what you would provide for them.

Such an approach is bound to land you in the top tier on next year’s report card.

Best regards,
Trisha Torrey
Every Patient’s Advocate

PS:  Patients can find New York State hospital report cards by linking to http://www.myhealthfinder.com/newyork11/. Pay particular attention to patient safety and satisfaction measures. Then use those scores to choose where you want to be hospitalized. Your life may depend on it.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

More Hospital Report Cards (more states)

How to Choose the Best Hospital for You

A Patient’s Guide to Hospital Infections

How to Prevent Hospital Infections

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Don’t Let Your Medical Test Results Fall Through the Cracks

(as published in the Syracuse Post Standard August 30, 2011)

A few years ago, I changed primary care doctors.

The one I left had good credentials. Over the span of a few years and several visits, she had seemed competent and was friendly.

But on my final visit, there had been a change that caused me to leave her practice. It came in the form of a sign which hung on the walls in all of her exam rooms.  It said, “Please do not phone us for your test results. We will call you if there is a problem.”

I was stunned; although I knew immediately why she imposed that policy.  It costs time and money to phone all those patients, make copies and mail them.  She decided the expense wasn’t worth the failsafe. As her patient, I found that to be dangerous and unacceptable.

A study published in 2008 illustrates why this is a problem. It focused on mistakes made during the ordering, administering and reporting processes of primary medical care tests.  The report showed that seven percent of results that went unreported to the patient resulted in additional problems for that patient including delays in treatment, further pain and suffering, and more out-of-pocket expense.

Evidently my former primary care doctor finds it acceptable to intentionally drop the ball on care for seven percent of her patients.  Those weren’t odds I was willing to accept.

Few of us visit our doctors anymore, primary care or specialists, without being tested for something.  Blood work, urine tests, a CT, MRI or any other test…. No matter whether the results are perfectly normal, or identify a problem, we need to know where we stand and what to change, if necessary.  Their results are always important, and we patients must always know what they are.

When you are given any sort of medical test, ask how and when the results will be reported to you.  Don’t accept a “don’t call us” reply.  When they phone you with results, ask for a follow-up copy by email or postal mail.  If you don’t hear back when they say you will, call the office of the doctor who ordered the test and bug them until they come through.

Doctors’ practices are becoming busier than ever. It’s easy for test reporting efforts to drop through the cracks.  Don’t let your test results be among them.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

How to Get your Medical Test Results

How Primary Care Doctors are Dropping the Ball on Medical Tests

How to Get your Medical Records

How to Correct Your Medical Records If There Are Mistakes

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Informed Consent Requires Clarity – Do You Have It?

(as published in the Syracuse Post Standard August 16, 2011)

Recently I was chosen to participate in a new writing project. There were some basic details and responsibilities I was expected to agree to, including a specific number of articles, average number of words, and some other typical expectations.

I was given a contract to sign. After a careful reading, there were some strange differences from others I had signed in the past. I found some hedge words in the contract which could mean I would do all the work, but they could decide not to pay me, yet still have the rights to use my work. Red flags!

I didn’t jump to conclusions. Instead I asked questions. “Will you explain what this means?” “Will you give me an example of how this might work?” Eventually we clarified the fuzzy wording, worked out the terms, and I signed the contract.

But – and this is important – I didn’t sign it without making a few alterations to the descriptions. Each party initialed those changes, then signed the contracts.

So why should you, my reader, care about my writing contract?

Because every time you need certain medical tests, any medical procedure and many treatments, you are asked to sign a contract, too. It’s called “Informed Consent.” By law, those services cannot be performed unless your signature is obtained ahead of time on an Informed Consent document. That consent provides legal protection to both you and the person who performs the service.

The real question before you sign is, have you been thoroughly informed? Do you understand the risks, benefits and alternatives to whatever service is about to be performed? Do you know exactly who will perform it? Have they managed your expectations?

Sometimes Informed Consent documents will have hedge words or statements in them, like my contract did. For example, “to be performed by Dr. Serg Ury or his representatives” may mean your surgery will be performed by someone you don’t expect. Just who are his representatives? They might be his partners, or they might be students. If it is important to you, then clarify, and change the wording if necessary.

Wise patients never sign an Informed Consent document until they are very clear on what is about to happen, who will be making it happen, and what the risks, benefits and alternatives are.

Clarity will provide confidence that you understand what is about to happen, and that you’ve made the right choices for you.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

Understand Informed Consent

Trauma from Violations of Informed Consent

Patients’ Rights in the United States

How to Prevent Surgery Mistakes on the Day of Surgery

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