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April 13, 2010 News 3 Comments

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From the “Other” Trenches
By Camus

I find the “In The Trenches” pieces intriguing. I only wish I had more time to author some counter thoughts to the good doctor. 

I had a physical exam with my GP last Monday. This physician is a member of a 30+ doctor group across the street from a MAJOR medical center in a major city.  He’s been my GP for seven years. Upon checking in I received a clip board with sheets of paper to complete. Each sheet starts with name, address, phone number, and SSN — the usual demographics the office has laying around on fifty other pieces of paper in my chart. (This was after I waited seven minutes on hold to schedule an appointment as they have no online appointment request and four minutes on hold while I verified my own insurance eligibility because they lack this ability themselves).

Physical exam is fine, usual blood work, history questions, and then an EKG. My reason for the visit was both a physical and concern over a near syncope event two days prior. Something’s not right in the EKG and there’s mild concern of an electrical block from the SA node. GP suggests making appointment with cardiologist in practice. Check out. Lab work promised later in week.

Walk down practice hallway to cardiologist office. Inform the receptionist I’d like to make an appointment as I’m a referral from my GP down the hall. There’s an open slot two days later at 1:00 pm and I grab it. Validate parking ($10 instead of $20) and depart.

Wednesday, two days later, arrive at cardiologist’s office 15 minutes early and check in. Receptionist hands me clipboard full of “new patient” forms. There’s five forms and each begins with the requisite name, address, phone number, DOB, SSN, etc. Filling this out is a waste of my time, so I do it once and write “see previous form.” One form seeks extensive personal and family history, which also resides in my chart some 75 feet away but that no one bothers to forward. One form seeks information on why I’m there, which would be obvious if they had an electronic system and the order from my GP who’s in their practice. No worries, I’m difficult to upset. 1:15, back to cardiologist’s exam room.

Dr. Cardiologist walks in, introduces himself, sits, and asks, “So, why are you here to see me?”

Somewhat bewildered, I answer “Because my GP in your practice suggested I do after a Right Bundle Branch Block readout on my EKG from my appointment Monday, two days ago.”

Dr. Cardiologist: “You have a doctor here?”

“Yes, I have for seven years.  He suggested I see you after the EKG.  I also have a very slow heart rate, with a resting pulse of 42-45. Normally my heart rate’s around 50. I went to see my GP for both a physical and because of a near syncope event last Saturday.”

Dr. C: “You had an EKG here?  Ok, we need to get that. Hold on a minute….”

Dr. C rotates in chair and presses buttons on wall mounted speaker phone. Four rings, voicemail. He hangs up, presses more buttons. Four rings, another voicemail.

Dr. C: “It would seem everyone’s out to lunch. Sit here while I go get your results.”

Question 1: Why aren’t the results in front of him?

Question 2: Why isn’t my paper chart in front of him?

Question 3: Why isn’t the order from my GP sitting in front of him with my GP’s comments surround the RBBB?

As he’s departing, I tell him,“You may wish to get a copy of the stress echo I had five years ago.”

Five minutes pass and Dr. C returns with chart notes, EKG, and stress echo results. A much better dialogue ensues and I joke with the good doctor I can make his life much easier and not have his office waste the patient’s time.

“Why don’t you have an EMR, Dr. C?”

“We’ve been looking a long time. It’s very complicated. Anything we get must communicate with the hospital and their system.”

And I dig further, “Yes Dr. it MUST communicate with the hospital. And there’s over 50 systems that will do that. I know my Dr. GP was on the committee to select a system three years ago. What happened?”

Dr. C: “We’ve seen so many systems, I don’t even remember how many. You should really speak with the hospital.”

Clearly Dr. C wasn’t in a hurry to solve the paper, process, workflow, lost revenue, lost charts, and patient inconvenience nightmare. That was fine as I was more interested in getting to the “heart” of the matter for my visit.

We’ll see how efficient this week’s visit is when I check in for my stress echo. I wonder if there’s a form waiting for me to write my name, address, phone, and SSN.

And, this happens every day, thousands of times around the country.

Comments 3
  • I, too, wish you had more time to send more counter thoughts. Enjoyed your post. (You truly must be “difficult to upset”!!! )

  • response to Camus:

    we all share your frustration, but I have learned how to handle –
    * call for appointment – just my name & confirmation of birth date (yes, there are other paitients in this system with my name, so I give them this) – ask only to see my PCP for “periodic visit”
    * u[on check-in, I respond that they already have all this data and politely retuern the clipboard; I am then asked “are there any changes” – if so, I comply verbally and they can enter; I also just state I am there for a periodic visit
    * next into the exam room and another inquisitor – I now explain the purpose and confirm, by “eyeball” that it is written into my visit sheet that my PCP will read when he arrives; if questioned on history or anything els, I give my stock answer, “no changes to what you already have”
    * as to the frustrations with the referral, I ask to make sure that the com[plete information will be available for my visit when I make the appointment – in these cases I always make the appointment (as you did) in person at the specialist’s front desk

    good “tiliting” –

  • When my PCP moved to a group that did not have an EMR (he didn’t have a choice, as his company bought a group without an EMR and transferred him there), I switched PCPs so I could keep my EMR intact and not go back to paper. This was after MANY phone calls to try and get an appointment, transfer my records, etc, etc. Life is too short (and valuable) to put up with that.

    Guess I’m just a lot crabbier than Camus.

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