Behind Healthcare

Threatening to Sue is NOT the Answer

2011-02-12T07:51:00.000-08:00

We are a fairly litigious society nowadays, and the threat of lawsuits in healthcare is very real. People's lives are on the line and healthcare professionals are entrusted to both make the quality of life better and cure or manage disease and injuries. This is not an easy task, and most providers and staff take this extremely seriously and are under a great deal of stress. In addition, every licensed professional is regulated by a board of governors in some respect (Nursing Boards, Boards of Medical Examiners, etc.).

When a patient threatens to sue a provider or staff over issues, typically the patient will be on the losing end. I'm not saying that malpractice does not happen, and I'm not saying that those patients don't deserve compensation for wrong-doings. What I am saying is that a great many people threaten to sue for the reason that they think they know better than the doctors. Doctors are not infallible, however their schooling, clinical training, and residency given them more knowledge than most laymen can find on the internet.

Threatening to sue professional healthcare providers for not prescribing the medication you want is a fool's errand. This is the most common issue I've heard for people threatening to sue, and frankly it makes no sense. There are multiple ways to manage pain, and recent evidence shows that opiates are not necessarily the best route for pain management. Some people will benefit from opiates, most would benefit more from exercise or physical therapy. Simply put, suing because you want pain medication will not get you the medication and damages your relationship with a provider that is trying to help you. Also, just because your old provider prescribed the medication does not mean that a new provider will. Providers practice differently and come at issues from different points of view. Threatening to sue your new provider because your old provider gave you medication is not the right answer.

I want to be clear that some lawsuits are warranted, and patients should not lose sight of the fact that some providers are not great.

The point I want to emphasize is to talk to your provider / healthcare team. Have the conversation and be prepared to accept a hard truth that the provider may know more than you, and be prepared also to ask for a second opinion if you feel that you're not getting the best care. Most providers are happy to refer you to another provider once you've at least tried their recommendation. Communication is the key to getting the best result. If your provider is unwilling to answer questions consider another provider.

Threatening to sue does not solve the problem, and typically will not get the result that the patient is looking for. Communication and courage when discussing your care with your healthcare team is the answer.

Great Cause

2010-08-09T20:16:00.001-07:00

Starved for Attention
www.starvedforattention.org
Doctors Without Borders/Médecins Sans Frontières (MSF) and VII present Starved for Attention, a multimedia campaign exposing the neglected crisis of childhood malnutrition.

http://www.starvedforattention.org/take-action.php

Healthcare Tip

2010-08-08T21:37:00.000-07:00

Here's a quick tip for understanding healthcare:

You as a patient are both a human being to us, and also a number to us. I say this so that people understand that there are two ways healthcare professionals look at people. For example, most hospitals and clinics use some sort of metrics to determine their performance in comparison with themselves or neighboring facilities. In doing this we take the human element out and review that we are off target by XX patients. The main purpose of this is to ensure that we provide the best possible care to people though, thus returning to the human element.

Here's a true example: We monitor HEDIS metrics for all of our patients. One metric revolves around which drugs to prescribe for elderly patients, as some drugs are more harmful or less tolerable to elderly patients. We had a lady walk into the clinic just fine, but by the time she made it to the exam room, it was apparent that something was wrong. She stopped breathing, and by the swift actions of the MA and RNs on my team, we saved her life. What does this have to do with HEDIS metrics and drugs? Well, this lady was overdosed by her daughter accidentally because she was coming into the clinic for an MRI, and the daughter wanted to be sure that she was comfortable and pain free. In doing this, the daughter gave her an extra pain killer. Obviously this could have ended very differently, but again, swift action saved the patient's life. This type of situation is what calls out why we monitor the drugs that people take to eliminate or greatly reduce these types of incidents. In this case, the patient was both saved, and should never have needed to be.

So, the next time you get a call to remind you that you need a screening, blood work, or an imaging study, please take heed. You may feel like just a number that day, but it is for the purpose of making sure you as a person get the best possible care.

Drug Treatment in the Elderly (Disease Management in the Elderly)
Drugs and the Elderly: Perspectives in Geriatric Clinical Pharmacology

Healthcare Jobs

2010-07-30T19:28:00.000-07:00

I get a lot of questions on what different staff do and who they are. I've tried to provide a brief overview below.

An MA is a medical assistant with about 6 months of schooling. These staff typically room and discharge patients, take vitals, and do general office work for their provider. An LPN (licensed practical nurse) is in between an RN and an MA in skill level and can do some nursing functions with care plans from RNs or from protocols. They get about a year of schooling and can also do anything an MA can. An RN is a registered nurse who can operate under the verbal orders of a provider, operate outside of protocols as necessary within their scope, and use more critical thinking skills. The minimum education is about 2 years.

I use the term provider to describe physicians and allied health (nurse practitioners (NPs) or physician assistants (PAs)). Physicians are skilled at a high level and can have their own practices under their own license. Allied health staff are also highly skilled, and can do almost anything a physician can with limits and differences. There are two main differences between a PA and an NP: 1. An NP has to have been a registered nurse at some point. Some people go straight from nursing school to get a bachelor's an then on to an NP, but at some point in there the nurse had to become registered. 2. An NP can practice on their own, while a PA must practice under the license of a physician.

I hope that gives you a good overview. This is not to be all inclusive, but generally helpful information.

Healthcare Reform

2010-07-25T15:57:00.000-07:00

Healthcare reform will reward providers that manage and coordinate services more cost effectively while improving quality of care. I think this is an interesting point. As we deal with the healthcare reform changes, consumers should become more aware of the interactions with providers and the healthcare system. Costs should be tied to need, in that, we should be able to charge people for the cost of a procedure if they insist on it regardless of medical effectiveness. The more people have to pay for the over-use of care that they demand, the less they will demand it. Patients and the medical community should be shifting our focus to maintenance of care and preventive medicine, not necessarily the latest and greatest surgeries and miracle pills.

There are five chronic diseases / conditions that account for the majority of healthcare costs. I see nothing in reform that addresses controlling these five issues. Diabetes, Coronary Artery Disease, Depression, Congestive Heart Failure, and Asthma constitute the majority of all healthcare spending in the US (Halvorson, 2007). We have made an important step in recognizing the need for change, however, the change we landed on does not get us to long term stability. We must change the way we pay for care, and we must focus on preventing disease and maintaining care. I recommend reading George's book, its a good overview of the whole situation, and it provides some great data. I don't agree with everything in the book, but it gives you great information to start from.

Realistic Expectations

2010-07-21T20:44:00.000-07:00

I had a patient come into my office in the clinic today demanding to be seen for an emergent issue. I thought that this member was having chest pain or shortness of breath and we may need to get an ambulance. She was yelling for someone to come help her, so naturally I thought it was a serious issue. She was constipated. She had been for two days. She called in and left a message for our RN advice line three hours before and felt it was unreasonable to have waited so long, so she came in. Unfortunately, my staff were dealing with patients in need of medical advice for lacerations, radiating chest pain, and sever abdominal cramping (to name a few) and were unable to call this patient back.

A realistic expectation when obtaining healthcare is crucial to ensure that you get what you need, and you are also not over-reacting to different medical conditions. When you have a major medical issue, you want your healthcare team to be able to respond. We cannot do that if you call for two day old constipation or a stubbed toe, so please be reasonable in utilizing our medical resources.

Please note that I am not trying to give medical advice here and that there are many co-morbidities that may make constipation a more serious issue. Those should be discussed with your doctor. My point is that most people know if they have a co-morbidity that would make constipation more serious than a person who has not had enough fiber.

Best Hospitals 2010-11: the Honor Roll

2010-07-15T21:45:00.000-07:00

Best Hospitals 2010-11: the Honor Roll

Ranking care delivery - HCAHPS

2010-07-15T20:21:00.000-07:00

People are often perplexed at hospitals and care delivery systems. They are not sure where to go, or who provides the best care. To meet this need, Medicare and the Department of Health and Human Services created the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in 2002 (Centers for Medicare & Medicaid Services, 2010). The intent of the survey is to "produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers" (Centers for Medicare & Medicaid Services, 2010). In other words, this is a complex customer satisfaction survey to rank care delivery systems. The information has been made public to help inspire systems to perform better and provide better patient care (Centers for Medicare & Medicaid Services, 2010).

If you want to know more about the healthcare delivery systems in your area, simply go to http://www.hospitalcompare.hhs.gov/ and search for hospitals in your area. I recommend the graphs view as it is easy to see how clinics and hospitals rank against the national average and neighboring facilities.

Reference:
Centers for Medicare & Medicaid Services, (2010). HCAHPS Online. Baltimore, MD. Retrieved from http://www.hcahpsonline.org 7/15/2010.

Tip for the week

2010-07-11T11:28:00.000-07:00

Opiod Therapy plans, or pain management plans are a touchy subject. Sometimes people misunderstand the intent of these plans. It is not the intent for the provider to just give you pain medication. These plans are designed as a partnership in managing the pain of the patient. That means that the patient needs to hold up their end of the bargain (i.e. urinalysis as requested, only using the correct dosage, etc.) in order for the provider to hold up their end of the bargain. Providers don't want patients to be in pain, but they also don't want to lose their license. Abusing the OTP or PMP can put the provider's license in jeopardy. So, work together with your provider to make sure that you stay on the right path.

Great books on Healthcare

2010-07-05T20:34:00.001-07:00

Quick Tips

2010-07-05T13:18:00.001-07:00

You want action from a Healthcare company or insurer, but you aren't getting anywhere over the phone or in person with the folks you interact with, here are some quick tips to escalate as needed.

1. Don't threaten to sue unless you really do have a case, i.e. true neglect or malpractice. These companies have large legal armies ready to go to battle, but we all know that you're blowing off steam. When I hear that you're 'going to sue' I think you have lost your mind. Instead, ask if you can work with the company to make the situation better. Some companies have quality committees that allow patients and their families to participate. Be the solution, not the litigator.

2. Be polite when you complain, and never curse! Using profane language discredits your argument and gives me and my staff the right to hang up the phone or ask you to leave. We know that we're not perfect in healthcare, but bad language doesn't help anyone fix anything.

3. Do talk to your healthcare team. Chances are most of the issues that come up can be worked out amongst the team, and you (the patient) are part of the team.

4. Ask for a second opinion. Remember that medical professionals are in the business to help people. They are not in the business to give out prescriptions or slips for work. They will do what they feel is medically appropriate. Two providers can have opposing views and that is okay, and it does not mean the one you do not choose to listen to is an idiot.

5. When communication fails, complain to management. In general, the squeaky wheel gets the oil, and healthcare is no different. In fact we have many agencies (like CMS) that dictate the time we have to respond to complaints. Caution here - don't think that everything warrants a complaint, and not every complaint will resolve the issue the way you want. However, complaints tend to form patterns that we observe and address the root cause of the pattern (i.e. phone call response time). This doesn't happen over night, but we do need to know.

6. Be realistic. Don't expect a phone call from your provider or healthcare team in anything less than 2-3 hours. If you can't wait that long, chances are you need to go to the ED or urgent care. We try to respond as quickly as possible, but urgent matters take precedent.

7. Be patient, but be zealous. We are a customer service business like no other. Life and death decisions are made daily in clinics and hospitals, insurers impact your financial health as well. Please understand that with that weight on our shoulders, we often err to the side of caution and conservative approaches. If these are not meeting your needs, talk about it with your healthcare team and give constructive feedback.

Choosing a Durable Power of Attorney, my thoughts

2010-07-05T10:43:00.000-07:00

1. Diligence – I need to know that the person making my decisions will not jump at the first solution offered, but will provide enough due diligence to ensure that the most accurate and best care is afforded me.
2. Communication – I want to know that I have been listened to, and that this person is talking regularly with my care givers. I want to know what is going on, and I want to know as soon as the DPA knows. Only if I am unconscious is it okay not to keep me in the loop.
3. Tenacity – Doctors and nurses are short on time and overloaded with patients these days, so it will take tenacity to ensure that questions are answered and answered fully.
4. Patience – I’m most likely going to be scared, somewhat isolated feeling, and probably frustrated that I can’t make my own call. I am also quite stubborn and just need my DPA to understand that.
5. Humor – Again, scared over here, make me laugh to keep my spirits up. Even if I’m dying, I want happiness and humor around me to end my days.

Two advances of biomedical technologies

2010-07-05T10:38:00.000-07:00

Two advances of biomedical technologies are Human Growth Hormone (HGH) and the creation of synthetic genes (Levine, pp. 208-9). HGH is used to help children with low hormone production reach the top cabinet by helping to increase their height. Synthetic genes show promise for a number of uses including restoring and strengthening muscle, and increasing memory (Levine, pp. 208-9).

Pros – Biomedical advances in the past have helped cure diseases like Polio and small pox, significantly reduce the amount of deaths annually from flu and pneumonia, and repair and replace pieces of damaged organs (i.e. heart valves). We have the unparalleled ability today to cure and prevent debilitating diseases because of these advancements, and we have saved and extended thousands of lives.

Cons – Unfortunately as we develop better ways to prevent and treat the diseases we are familiar with, Mother Nature seems to throw in the twist of mutating the virus or humans change habits that lead to other issues. The common flu is much less of an issue today than it has been in the past, but the mutations of the flu can be catastrophic as we saw just this past summer with H1N1 and the death ratio it had. As we find better ways to treat, so viruses find better ways to adapt. Also, as mentioned in the Sandel article, certain advances open the door to a slippery slope to genetically engineered perfection.

Reference:

Levine, C. (2010). Taking Sides: Clashing views on bioethical issues (13^th ed.). New York: Mc-Graw Hill.