It’s been awhile since I last posted. My apologies.  I’ll try to do better.  I thought retirement would give me more time to focus on this blog, but it seems to give me more distractions.  Since my last post, I’ve once again seen some issues with being a patient in our healthcare system that deserve some comment.  This post will talk about one that those of us who have moved around the country face – keeping track of our medical records, in other words, health record portability.  We may have paper records that we carry with us, but the more we have, the harder it is for our new physician to pour through them and incorporate them into the current record.

What brought this topic to my attention was my recent need to find documentation of a pneumonia vaccination that I know I received within the last few years.  Was it done at my doctor in Knoxville or was it done at a pharmacy while I was on vacation in Florida?  I can’t find the record of it within my paper files.

In this digital age, it seems that certain aspects of our healthcare delivery system have not kept up with technology.  Our medical records should be digitally portable.  If you had surgery in Richmond, VA and now moved to Charlotte, NC a lot of that information may not be readily accessible to your new healthcare providers.  What are the current obstacles?

1. Not all physicians or healthcare providers use an electronic medical record (EMR)
2. Not all significant healthcare information is contained in the EMR
3. Not all the EMR systems that are operational can share information
4. Even where sharing is possible, it’s often not automatic

Next time I’ll talk about some solutions that are on the horizon.  In the meantime, please feel free to share your comments and thoughts.

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.)

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

In the last post I talked about what characteristics of your symptoms should lead you to contact your physician. This time I want to discuss what else to consider.

Sometimes they know the on-call doctor isn’t their own, and they don’t want to talk to them.  The reality is that all physicians are trained to handle such after hour calls.  Delay can sometimes lead to complications that can be life threatening.