Shortly after publishing my last post, The $29,000 Appendectomy! (Brought to You by Cost-Shifting), my daughter e-mailed me a link to a video on the CNN website in which Dr. Sanjay Gupta gives some further insight about hospital charges and cost-shifting. As always, he did a terrific job, and I urge you to Click Here to check it out.

I’ve always admired Dr. Gupta’s interviewing skills and ability to clearly explain some complicated medical issues to his audience.

As always, I welcome your comments!

For Your Health – Dr. Bob

When you go to your doctor for some new symptom, realize that there will be a clinical process for your workup that could involve many steps, so think ahead!

I’m not suggesting that you will know exactly what tests will be necessary to evaluate your condition, but you can still think ahead.  In many instances, your PCP will have a pretty good idea what kind of treatment your symptoms will require.  In most cases, the tests he orders are done to confirm his suspicions.  With that in mind, if surgery is a strong possibility and you have a history of a chronic condition such as diabetes or heart disease, you may wish to schedule a pre-op evaluation by the specialist who cares for you for that condition.  Why?  Because these doctors are often very busy and you may have a long delay to get such an appointment.  At the very least check with the receptionist how quickly you can be seen if you need clearance before surgery.  In my case because of my heart history I knew I needed to be cleared by my cardiologist.  I also knew because I hadn’t had a recent stress test, he would probably want me to have that done prior to his giving me clearance. I was correct & getting these done added about two weeks to the process.

Next time I’ll discuss evaluating your treatment options to make sure you get the best care you can!

For Your Health – Dr. Bob

(To view the case of the original post, go to Case 1.)

Follow-up care is essential to assure good outcomes, but for some people getting a ride to the doctor can be a problem.  So, put yourself in Susan’s shoes.  If you couldn’t drive yourself, what would you do?  Here are some options:

• Most would jump at the chance to be of help.  After all, some day you may be able to return the favor. 
• Depending on where you live that could be quite expensive or cumbersome. 
• Contact them to find out.
• The social workers there are aware of all sorts of programs in the community to help its citizens with a variety of needs, such as transportation. 
• He may know of another way to address your transportation difficulty.

I used Case 1 under Cases To Consider to describe an actual situation that a real person faced after she came home from the hospital.  I named her Susan and outlined the problems she encountered getting the care she was supposed to get along with how I would overcome those obstacles.   I hope you found these to be useful in understanding some of the important components of a hospital discharge and how to work within the healthcare system to stay your healthiest.  I welcome your comments and questions. 

For Your Health – Dr. Bob

(To view the case of the original post, go to Case 1.)

After calling the home health agency, she learned that they hadn’t received the order from the physician.  When she tried to speak with physician she seemed to get nowhere and was waiting for a callback.  This raises the third issue – a practice that seems unresponsive.  You’ll notice I didn’t say a doctor who is unresponsive.  From the information we have, we don’t know that yet.  From my experience, patients often don’t know how to convey the most important information to enable the office receptionist to make the best decision.  The message sometimes lacks important information to convey the appropriate priority.  If Susan just said, “Hello, I’m Susan, Dr. Smith’s patient and I need to speak with him.  Please have him call me at XXX-XXXX,” that probably won’t rise to the top of the priority list. 

First of all the clinical training of the receptionist varies from practice to practice.  Usually it’s not a nurse who answers the phone, so in most instances their medical knowledge is limited.  In many practices there is a nurse who works with one or more of the physicians.  One of the responsibilities of this nurse is to handle many of her doctor’s patients’ issues.  This is the person you want to make sure gets an accurate message.  The receptionist who answers the phone will usually relay the information you have given to that nurse or the doctor. Sometimes the nurse can take care of some issues without the doctor having to call the patient back.  For instance, if Susan relayed all the necessary information, the nurse could have gotten her physician to complete the required paper work and forwarded it to the home health agency without the doctor calling Susan.  It’s critical that you communicate effectively.  Here are some suggestions:

1. The nurse will have a better clinical understanding of the importance of your clinical issues.  If there is no nurse, the next steps are even more important.
2. Be clear and direct.  If you need the doctor to make sure to sign orders with the home health company so you can get the care necessary for your recovery, say so.  Also state that you want to be notified once he has done that.  (You’ll see below why that’s important.)
3. If you can’t speak with the nurse or doctor then, always get an estimate of the time when the physician or nurse will call you back.
4. But first she needs to call her doctor one more time to determine what, if anything, they have done.  (Sometimes the practice takes care of this kind of thing but doesn’t let the patient know.  In this way the doctor doesn’t even need to call the patient back.  But unless someone calls the patient, they are waiting for a call that may never come.)  If it hasn’t been taken care of yet, I would let the practice know that since I need the services, I’ll be calling my insurance to see what they recommend.  This may move your issue up in priority and get it resolved.  Otherwise, go ahead and call the Customer Service department of your health insurance to enlist their help.  They have a whole team of staff who work with physician practices who should be able to resolve this.  If you have to take this route, you probably need to find another more responsive practice, so see my last recommendation.
5. Most physicians take pride in being accessible to their patients.  Gauge your physician’s reply to your concern.  If it is unsatisfactory, you may want to consider my next suggestion without waiting for a recurrence.
6. If your health plan requires you to use an in-network physician, call the Member Services number on the back of your health insurance card for help in identifying other suitable, in-network physicians in your area.  You may also want to mention to them your reason for changing doctors.

Please share some of your experiences.

On the next post I’ll talk about Susan’s transportation problems.

For Your Health – Dr. Bob

(To view the case of the original post, go to Case 1.)

  If there are questions, it is a lot easier for the nurse to resolve the issue than it will be for the patient to take care of them once they are home.  Bottom line – you as the patient need to know exactly what the plan is for your continued recovery and when various visits are to take place and by whom with contact information for those other care providers.  In certain instances you may need to schedule some of these and you need to know which and get them scheduled ASAP after you return home. 

I would also emphasize that after discharge a patient should set up a post-hospitalization visit with their physician as instructed in the discharge instructions.  In most instances that should be within 2 weeks, but depending on the reason for the hospitalization and the treatment, it could be a lot sooner.  Also, you should not hesitate to call your physician if you notice new or worsening symptoms.  Sometimes an evaluation of these can wait until your scheduled appointment, sometimes not.  Sometimes, these symptoms can be due to a life threatening complication so time is of the essence.  That’s why a call to your doctor can be so important.

So, what should you as a patient being discharged from the hospital do to assure a smooth transition home?

• If possible, have a reliable relative or friend with you when you get your discharge instructions.  For most hospitalizations you will not be able to drive home by yourself, so the person picking you up can help with this.
• Ask for a copy of your discharge instructions so you can look at them while they are being read to you.  Follow along and make notes on the paper.
• Make sure that any questions you have get answered before you leave.
• Make sure you understand what are your responsibilities once you get home, for example, when does the doctor want you to make an appointment to be seen in the office?
• Make sure you know what other components of care you will be receiving and whether you need to contact anyone before those appointments begin.
• Always get contact information for any of the other care providers who will be working with you.
• VIP!  Make sure you know what medications you should be taking and whether the medications you were taking before admission should be stopped or continued.  I have heard of instances where a person was taking a brand name medication before admission and was discharged on the same drug but the hospital staff referred to it by its generic name.  When they got home the patient took both medications and had significant side effects from the double dose that required an emergency hospitalization.  Such mistakes can be fatal.

So with some preparation this issue Susan encountered might have been avoided.  In the next post I’ll discuss what to do to make sure your doctor calls you back.

For Your Health – Dr. Bob