Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, August 29, 2007

Grand Theft Patient

She started coming to me because she didn't like the impersonal care at the Enormous Group Practice that dominates at the hospital, though she likes the hospital because it's close to home. All she was taking was Synthroid and aspirin.

Until I sent her to the ER with new-onset A-fib.

Two months later -- not a word from anyone in the meantime -- she comes back with a med list that includes two antiarrhythmics, warfarin, a diuretic and FSM knows what else. What happened? Is she in sinus or A-fib with a controlled rate? Who's managing her anticoagulation? What about those new skin lesions on her arm? Drug rash or something else?

It's the oldest story in the world.

When she presented to the ER, they already had her in their computer as an EGP patient. Never mind that she (and her daughter) specifically told them I was her doctor now. Nope; once you're in that computer, you're theirs for life!

That doesn't stop me from calling over there, intending to politely chew them a new one. "The cardiologist isn't here today, and his nurse has Wednesdays off." (Damn; I should become a nurse.)

I do the best I can.

I'm pretty sure the skin lesions are hives, but they're awfully localized and really round, so I do a lyme test to be sure. I do a thyroid test because even though her TSH was fine two months ago, one of her new meds doesn't play well with Synthroid. They've been managing her Coumadin, so I don't mess with that for the moment. Her pulse is 48, but she's as impressively asymptomatic as she was when it was 150.

Finally (2 days later) the cardiologist calls back. He's so sorry, but they already had her in their computer as one of their patients, so he didn't worry about it. Next time I should call and they'll be sure to keep me in the loop. (I did call the ER when I sent her over. How many more times should I call?) He was very sorry, though. By now I have her negative lyme test and have adjusted her Synthroid. Has he seen any strange drug rashes lately? No, not really. He's no help, but he's very sorry about the mixup.

My only real recourse is to "vote with my feet" by not sending patients to this hospital anymore. Unfortunately, medical care has more in common with real estate than anyone like to admit: location, location, location. When patients don't want to travel, I'm stuck. So I just have to suck it up and go calling around to get discharge information.

Ah well. Now I have to go track down what happened to the guy I sent over for a stress test who wound up in the ER.


At Wed Aug 29, 11:37:00 AM, Blogger Lynn Price said...

Whoa, Dino, how scary is THAT? We patients are under the impression docs all talk to each other in order to keep us medically safe and sound. If this ever happens to me (God forbid), I'll be sure to scream like a bloody banshee that they contact my doc.

At Wed Aug 29, 12:34:00 PM, Anonymous Anonymous said...

I think Abbot and Costello where predicting the future of communication in medicine when they came up with their routine "Whose on first?".

How hard is it for hospital staff to note the referring doc and make sure he/she receives a copy of the discharge summary? Actually, not hard at all, just takes someone who is interested!!

At Wed Aug 29, 02:46:00 PM, Blogger Elaine said...

I found this as a patient when I moved to one practice's catchment area to another's just because I had visited that hospital once before, I was still a patient of the previous GP. This does not only drive the doctor mad!

At Fri Aug 31, 04:13:00 PM, Blogger ccinnkeeper said...

Just curious, why did you send the PT to the ER instead of referring directly to a cardiologist? Was the A-fib so worrying that it needed to be seen right away?

As someone who has had an arrythmia for 28 years, undiagnosed and untreated for the first 20, I tend to think of these events as non-life-threatening. Of course mine is episodic, not constant, and turned out to be v-tach instead of a-fib, so what do I know?

This story does make me think there ought to be some better notification system in place, however in the interim I think I'll make it a practice to get copies of all my own records for any future ER visits. At least that way I can put them into my doc's hands myself.

At Sat Sep 01, 12:29:00 AM, Blogger BillyBob said...

I allways take my laptop to every doctor appt. and ER visit, and hospital stay, Why? Because every clinic note, CT scan, MRI, x ray, all past labs, my symptom notes, Meld scores, etc are in there. Last week my Hepatologist said "need a copy of your last outside CT scan" I just burned him a copy on the spot. Yes his jaw hit the ground. But I do not want to fall through the big gaping cracks you just described. The health care machine is a BIG LUMBERING BEAST.

At Sat Sep 01, 10:52:00 AM, Anonymous Anonymous said...

"(I did call the ER when I sent her over. How many more times should I call?)"

The sad fact is you probably should have your staff request records from the ER visit as soon as they are available. In my expereince only about 1/3 of pt's seen in the ER actually get some type of record back to me (more often it is the pt than the ER sending the record). The culture of the ER is that nothing actually exists from a medical standpoint outside the ER except when it is needed by the ER (which I don't argue about in a true emergency). Additionally, your typical ER nurse gets so jaded and nasty after 5 years in the ER, that their should be a requirement as to the maximum number of years they can work there and then move on to other nursing areas ofthe hospital/clinic.
PS: Before I get creamed on this I have worked in ER's intermittently for many years, so I have seen this firsthand.

At Sat Sep 01, 02:43:00 PM, Anonymous Anonymous said...

Billybob- instead of taking your laptop, wouldn't it be easier to just put all that info on a USB memory stick? Or maybe a PDA like a palm pilot or something?

Someone should make a little pocket-sized portable gizmo with a screen that can do all that that patients can carry with them.


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