The Doctor Is In: Really? Health Care Delivery Ain't What it Used to Be Part 2

Medicine: a noble profession, with well-intentioned people. Don't get slack.

Posted Oct 31, 2011

"If no response in 45 minutes, call back." 45 minutes? What happened to the doctor or PA returning your call within 1-15 or 20 minutes; i.e., as soon as possible? Many times when in the operating room, when many of those of my generation, we'll receive a page and have the circulating nurse return the call and relay the basic message to us (or, if it's possible to break away for a minute, the phone would be put to our ear to listen to the patient directly) to at least answer the page in a prompt manner in consideration of the patient's concern.

One experience I learned of: A patient paged their doctor around 9 PM due to bad pain. The doctor never returned the call. Upon the patient's third call to the answering service, the operator called the "on-call" provider herself, only to learn that the person scheduled to be "on-call" was actually the PA (physician assistant), and she was on vacation! (The answering service wasn't aware of this fact.)
When checking to see who was covering for the PA--surely she wasn't on call without physician back-up--the operator paged the back-up physician. This was approximately 10:30 PM. No response from that doctor; at least not until 5:30 the next morning when the doctor called, saying," Yes, uh, did someone page me?" The patient replied, "You were paged last night." Response: "Well, I was sleeping when that page came in so I'm calling you back now." Excuse me?

When I trained, interns and residents worked over 100 hours a week. While that was quite ungodly, and can increase the chance of making a mistake, that was the norm. It now is against the law to work such hours. I understand. But in private practice, as it should be now, if you're "on call," it's exactly that...meaning when a patient calls you, you answer. Wake up and respond to your patient. Obviously if the patient is calling after hours, there must be some concern too great to wait until the morning, but not serious enough to "call 911."

While doing peer review of malpractice cases, I had the unfortunate experience of reviewing a malpractice suit which literally made me cry [there have been a few cases that have]. Despite overwhelming circumstances that begged for the doctor to go to the hospital and asses the patient, the defendant doctor kept giving verbal orders to the anxious nurse over the phone between 1 AM and 5:30 AM. The doctor would be off call at 7 AM and likely was hoping the patient would ‘keep' until then--when the next day's doctor could swing by, make rounds, and see what was going on. Without going into details, the patient had a tragic outcome, and the doctor was found negligent and lost a multi-million dollar lawsuit.

Beware standard electronic records documentation. Electronic medical records can help the practice of medicine in many ways, and they can help keep a patient's information cohesive and accessible (in the good way). But I have noticed that the electronic record system used by many hospitals and offices afford the doctor documentation of things not actually done. I noticed this myself when reviewing the ER records after my car accident.

I noticed that the electronic records will provide what a "normal" exam would be, and what it should include, but a doctor might check "normal" without actually having done all of the maneuvers that are included in that "normal" assessment. This automatic inclusion of positive or negative findings may help the physician if sued, but I fear that it makes some doctors slack when doing the exam and documenting the actual findings during a patient's exam.

Robotic surgery. You've probably seen the commercials in which hospitals boast that they have the fancy, hi-tech robotic surgery machines with which surgeons can perform surgical procedures with smaller incisions, initially using the same devices used in endoscopic/laparoscopic surgery. But with the robotic surgery, the surgeon is actually a good distance away from the patient. The doctor isn't even at the patient's side.

I will say there are some fantastical benefits to this type of technology--robotic surgery: Smaller incisions; great visual acuity for the surgeon, and more dexterity in many cases. True. In fact, the unit is named "the DaVinci," after the famed artist, because we, as surgeons, can create a pretty picture of a disease-free abdomen or thorax (chest area). But the distance away from "the patient's side" seems cold and detached; impersonal. But, again, there are benefits to some of these robotic procedures, and some doctors say they are rather "fun" to do. Click here to read Part One of this post.

I love the practice of medicine. I feel it is the most noble profession and most people in it are well-intentioned for the good of their patients. I only pray that physicians, nurses and their staff will remember the basic tenets of our profession, and the special personalized care and attention our patients deserve...24/7.

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Copyright © 2011 Dr. Melody T. McCloud. All rights reserved. Any excerpts reproduced from this article should include a hyperlink to this--my original post on Psychology Today, with author credit. Feel free to post the link to this, and any of my PT posts, to your social network pages.

About the Author

Melody T. McCloud, M.D., is an obstetrician-gynecologist and the author of First Do No Harm: How to Heal Your Relationships Using the Wisdom of Professional Caregivers.

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