Doctor, You Have a Patient in Room 1

Forms, forms, more forms

Dr. Jane Irving — Wed, 17 Feb 2010 18:57:46 +0000

Don’t you hate going to doctor’s offices and have to fill out what seems like mountains of forms regarding your name, address, phone number, insurance, etc as well as all of your past medical history. It’s annoying, isn’t it. It’s so darn repetitive. It seems like we should be able to figure out a system to have all the information needed on some sort of electronic media that is secure, portable and in a format that is recognizable and readable to anyone that needs it. Someday, that will happen. I wish I had the brains to invent something like that, because then I wouldn’t have to do what I do all day long – try to decipher a patient’s history and piece it together from what the patient tells me. Unti that happens though, can I please ask everyone to fill out my forms. Correctly. I know we are all busy, but it’s your own health & if you don’t tell me about it, at best I won’t be able to help you and at worst, it could be dangerous. For a while, I was just annoyed, and then I read an article about medical illiteracy in which they claim that most people don’t understand doctor’s forms and if areas are left blank, it’s because they don’t know what you are asking. So then I had about a month’s worth of compassion for these poor medically illiterate people. Until I realized that it’s a load of crap. Oh, all right, maybe 10% of my patients are very uneducated and truly need help understanding. But I practice in an affluent county where most women come in with their Nieman Marcus wardrobe and their perfectly coiffed hair, and are just too busy to take the time to fill out my forms. If I’m feeling pretty snarky, I like to make a game of it. I’ll be looking through their medical history forms that they have filled out and I’ll see big blank areas. So I’ll say, “Oh, Mrs. S, it looks like you’ve been very healthy. I see you’ve never had surgery before.” If they’re a form evader, they’ll hem and haw, and then admit they had a hysterectomy (for some unknown and bizarre reason, many people don’t think this is a “real surgery”). So I make a big show of writing this down in the previous surgery section, and at the same time saying very slowly, “And how many other operations have you had?” They usually come forth with 4 or 5 five other operations that they have had in the past. They do the same with allergies or medications that they are on. Call me crazy, but if I’m a patient going to a new doctor, particularly if it’s a surgeon and I might need to go the hospital and have surgery, I would make pretty damn sure that doctor had an updated list of all medications that I was on. Does the average Jane understand how many medication errors there are in this country today. But, I see patients every day that either don’t know what medications they take or they do, but are too lazy and apathetic to let other health providers know what they are. I have patients who are having some bleeding during a procedure say, “Do you think it’s because of the aspirin I take?” I say, “You didn’t tell me you were on aspirin.” They say, “I didn’t know it was important.” Please tell me that the American population is not that stupid. Aspirin thins the blood. If you take a medication, know the side effects please. To top it all off, guess who is responsible if a patient has a bad outcome due solely to a medication error? It’s not the stupid patient. It’s us hapless doctors who didn’t take a correct history. Please don’t be a form evader. At best, it’s tremendously annoying to your doctor (someone who may be taking your life in his hands) and at worst, it can be deadly.

Accountability

Dr. Jane Irving — Tue, 15 Dec 2009 04:54:54 +0000

It has been shown that a substantial percentage of illnesses in our society are self-induced. Take the example of a patient I saw recently. Mary is 40 years old. She is 5 feet, 3 inches & weighs 230 pounds – more than 100 pounds over her ideal body weight. She smokes a pack of cigarettes a day which she has done for the last 20 years. She does not exercise. She has high blood pressure and diabetes. She drinks 6 cans of Coke (regular, not Diet) a day and proudly informed me that she has cut down from 24 cans a day. This is a lady who stands a pretty good chance of not surviving to celebrate her 50th birthday. She could use some help dealing with the reasons for her unhealthy lifestyle. Maybe some tough love from TV’s Jillian Michaels from The Biggest Loser. On that show, however, people want to change. A lot of people want to make changes in their lives, but many don’t want it bad enough to work hard for it, like my patient Mary. Well, you say, no big deal, she’s a fool, she’s only hurting herself. And there’s where you would be wrong. Many patients like Mary can’t get health insurance because their premiums are so high. If you are a health insurance administrator, would you want to insure her? Of course not. As a result, many people are either uninsured or they have such high deductibles that they may as well be. So when that individual does have an illness, when they go to the hospital, they usually can’t pay their bill. The hospital takes a loss and to avoid going under what do they do? They charge more to the people who can pay to balance it out. The next time you get a hospital bill and wonder why they charge you eight dollars for a singe Tylenol, take a look at your neighbor or friend, your husband or wife. Maybe their lifestyle choices in part contributed to it.

Can I Call You Jane?

Dr. Jane Irving — Mon, 23 Nov 2009 06:01:37 +0000

So, let me tell you about Muriel Hardeman. In the name of HIPAA which protects patient privacy, all patient names will be changed in this blog, just as my name is changed. Part of the fun will be thinking up names. Speaking of names, medicine has a long-standing tradition that patients call their doctor Doctor Smith or Dr. Jones. It’s a sign of respect, and doctors are equally charged with respecting their patients by calling them Mrs. Smith or Mr. Jones. Some patients complain when doctors use their first name without asking. They feel it is presumptuous and disrespectful. Having said that, in this day and age, the surname is used less often than it used to be. People are a little more casual with each other. When I was growing up, you would never dream of calling your friend’s mom Doris. It was always Mrs. Dillard. My son, however, calls our neighbors Joann & Jim, and our other neighbor, Auntie Sue. Many of his classmates call me Miss Jane. Nonetheless, I always try to respect my patients and use their surname unless they tell me otherwise. Or sometimes, I’ll ask them if I can use their first name especially if they are significantly younger than me. It feels a little strange to call a married 23-year-old Mrs. Springer. Not too many patients, though, call me Jane. Sometimes they will if I’ve been seeing them quite a while and we’ve spent a lot of time together. But I have to admit that despite the fact that I’m generally pretty easy-going and open-minded, it always feels strange when they do and I have to admit I don’t usually like it. It’s not an ego thing. It just feels too familiar. So, let’s get back to Muriel. Oops, I mean Mrs. Hardeman. I first met Mrs. Hardeman because she had an abnormality on her mammogram which unfortunately turned out to be cancer. Spry and 75 years old, she had somewhat of a high-pitched voice. I entered the exam room for our first visit and said, “Hello, Mrs. Hardeman. I’m Dr. Irving.” As I shake her hand, she asks in her squeaky voice, “Can I call you Jane?” Hesitating at the abrupt request, I smile and say “Sure.” It turns out that Mrs. Hardeman loves to use names in her sentences – excessively. “Tell me, Jane, about the biopsy.” “I’ve been very tired, Jane.” “Jane, I need a refill on my medicine.” Every sentence had my first name somewhere embedded within it. At first, I thought she was doing it on purpose to annoy me. So, I played her game and starting incorporating her name in all of my sentences – her last name. Didn’t faze her. I never asked her if I could call her Muriel, and I never did.

Mrs. Hardeman knew what she wanted, and rarely listened if someone told her no. When we were scheduling her surgery, I informed her that she wouldn’t have to stay overnight in the hospital. She said, “Jane, I think I’ll stay two nights”, as if she were booking a room at the Holiday Inn. I told her all the reasons that she wouldn’t need to stay in the hospital (minimal discomfort, quick recovery, etc) and why she shouldn’t stay in the hospital (increased risk of infection, blood clots, pneumonia, etc). I should have saved my breath; she stayed in the hospital two nights.

My best Muriel story, however, came about 10 days after her surgery. It was a 9am on a Saturday morning and I was at my son’s swim meet. I heard my cell phone ring which is miraculous in and of itself, since it’s quite loud at a swim meet. “Dr. Irving,” I answered. “Jaaaannnnne?” she says in her high-pitched squeak. “Hi, Mrs. Hardeman, what can I do for you?” She couldn’t hear me very well. “Jaaaannnnne?” she screeches again. I try to move to a quieter part of the pool area. “Yes, Mrs. Hardeman, can you hear me now?” “Jane,” she says, “Jane, I can’t hear you very well.” I try to move further away, almost to the parking lot, but it’s still pretty loud. “I’m sorry, Mrs. Hardeman, I’m at my son’s swim meet.” Big pause. “Oh,” she says. Not, “Oh, I’m sorry to bother you.” Not, “Oh, how nice.” Just “Oh.” She seemed a little put out. I think she expected me to be sitting at home by the phone waiting for her call. I haven’t seen Muriel in quite some time now, but by the end of our last appointment, I knew I had finally gotten somewhere with the name battle. She came out of the exam room and went to the check-out desk. I overheard her talking to the receptionist. “You know,” she said, “that Doctor Jane is so nice.” As Muriel sashayed out the door, I smiled to myself. I’ll take it.

What’s This One All About??

Dr. Jane Irving — Thu, 19 Nov 2009 21:04:29 +0000

Let me start off by saying that the picture on the right side of the screen is not me, but that’s probably what I’ll look like in another several years. I love my patients – I really do. But, as with anybody in a service industry, some of them are funny, some of them are crazy, some of them are frustrating and some just plain make me mad. But they all require professionalism, compassion and my expertise. So to cope with the foibles of human nature that I encounter every day in my private practice and to keep me from looking like the lovely lady in the photo by my next birthday, I have decided to write this blog. My goal is to vent, so if no one ever reads it, I’m good with that. But if you want to see what goes on in a medical office from a doctor’s perspective, pull up a chair.