Yeah, not a good idea to post something like that, here or anywhere else.
In the mid 1990s, I worked at a mail order pharmacy that got the contract for the Screen Actors’ Guild. 90%+ of the people enrolled are not famous by any stretch of the imagination, but I did call a few movie stars’ houses to ask them about drug allergies and the like, and we knew that a classic actor/actress was terminally ill 6 months before it hit the tabloids. And don’t get me started on the Beverly Hills Dr. Feelgoods…
Or maybe that the patient just wanted to be involved in his/her own care, and in the driver’s seat, and the physician is trying to ram the maximum number of patients a day through his/her practice.
High-maintenance patients exist. No doubt. So does the kind of physician I just described.
Seems common around here too, though I found it odd when I first encountered it. From my own medical report:
I am asked by Dr. X, general surgeon, to render a preoperative consultation for this very pleasant 28-year-old Caucasian man who is scheduled for elective cholecystectomy.
I was actually quite grumpy at that point, being in fairly excruciating pain. But I guess “very pleasant” is relative.
Since you handled them, I assume you were supposed to be reading them. But I recall, when (IIRC) Michael Jackson was admitted to the hospital on the day he died, some of the staff pulled up his records. They were essentially getting a play by play of what was happening as things were getting entered into the system. They were fired or otherwise disciplined. While they were likely aware they weren’t supposed to be doing it, what they apparently weren’t aware of was the audit trail, meaning someone somewhere can see who accessed records. So if he was in the ER or ICU and someone from L&D pulled up his file, it’s a problem.
Plus, while I’m sure most were doing it just to see what was going on, no doubt some where leaking it to the media/TMZ, and probably got a couple bucks for it too. While maybe not enough to be worth losing their job over, it wouldn’t surprise me if TMZ offered a nice chunk of change to the first person to report/confirm his death. I’ve seen numbers range from $1000 to $250,000 that they’ll pay sources for “tips” like these. And, being a hospital in LA, I’m sure the staff is well aware that the media will pay (and pay well) for “tips” or pictures of celebs.
Well, this was in the early 1980s (Ruth Gordon died in 1985, so by definition it had to be before that). So “handling” meant touching physical records, because they were given to me. I never touched any records that I wasn’t supposed to have - given that it was all manual filing in those days, I suppose I could have looked for specific records, pulled them out and read them, but I didn’t.
Anyway, there was no paper trail the way there is now an electronic audit trail. But my fingerprints would not have appeared any place they weren’t supposed to!
In most cases, don’t blame the physician, blame the practice he works for.
My husband HATES the fact that he’s expected to see 25+ patients in a 6 hour timeframe. It’s not good for (most) patients, it’s not good for him, it only serves the practice’s bottom line. But they kind of have to do it because of the crazy staffing expenditures they have to have, and to offset insurance nonsense.
I was once in a hospital for a bit, and while I wasn’t belligerent or anything like that, I did not meekly submit to procedures that I had not been forwarned about by my doctor. (E.g. daily blood draws - my doctor said I needed only every other day - and so on.) Anyway, at one point a routine had been established so this was no longer an issue, and I got a new nurse who commented something to the effect that I was a much more pleasant person than she had been led to believe.
In this case, however, the alternative is that some of those patients don’t get any care at all. Depending on the situation, that could very well be (and likely is) a worse overall outcome for all involved.
In “this” case? What case? The post to which I responded didn’t describe any particular case.
I disagree with the “most cases” part of the post to which I responded. Most physicians don’t work in free clinics in poor, underserved areas, or prisons, or other situations where the only alternative to cursory care from a physician is no care.
Physicians have a responsibility to deliver care to their patients. If they’re working in a practice which requires them to put revenue ahead of patient care, they should either quit or change the environment. And (since the the post to which I responded frames the issue in a labor context) physicians have more ability to change their working environment than perhaps any other kind of worker
The post describes the general case of a physician seeing 25+ patients in 6 hours. The sad fact is that there are not enough medical providers, including NPs and PAs as well as physicians, in the United States. This will result in situations where some patient visits are shorter than optimal. IMHO that is still better than not receiving any medical care at all in situations where the illness is straightforward but at high risk of complications absent intervention. Take someone with uncontrolled diabetes or hypertension as an example. Would they be better off with a 30 minute visit where they get to discuss the various aspect of their disease process, including non-medication management, social factors that lead to a sub-optimal diet, etc. vs. a 10 minute visit where the doctor just reviews their glucose log or BP log and makes some quick adjustments? Yes, undoubtedly that’s the case. But those patient are also better off with that quick 10 minute visit than they would be not getting seen at all and running out of their insulin or BP meds.
I see many similarities between the Health Industry and the Police Industry.
Like with the case where a cop is on trial for killing a “suspect”, the jury is almost always allowed to hear any bad background the “suspect” had, but they never get to hear about any complaints or lawsuits the officers had.
In the health industry, the doctors had secret notes they put in your file about you, like your a difficult nasty patient. But you never get to see them, and you can’t put your notes in about the doctor like he did very bad stuff and you changed doctors because of it. You may have had a few bad doctors that add to these notes about you. And even if you got one of the doctors FIRED, when you go to a new doctor nowhere does it say in the patients file that his last doctor (who wrote bad notes) was FIRED. So you end up looking like the bad guy on paper no matter what you do.
Having seen many tens of thousands of patient records, it is exceedingly rare to see a doctor, or any other professional, write negative comments about a patient. There are no secret notes. This is partly because any patient can view their records on request, although a hospital or physician can charge a modest fee for copies. I can count on one hand the number of times I’ve seen it.
I don’t know the comparison to the police is apt. I suspect most officers stick to the facts.
There are new rules recently in place, I don’t know about psych records, but provider notes are now visible to patients in their EHR. A bit more disturbingly, is that as soon as labs are resulted, they are released to the EHR even before the provider sees them. This leads to some panicked phone calls.
There almost certainly won’t be comments like “patient is a jerk” or things like that. But there will be mention of things like “patient is non-compliant with treatment regimen” and things of that sort, if they are pertinent to the patient in question. In my particular area of practice, taking care of patients in nursing homes, there will also be mention of things like “patient became aggressive and struck another patient / the nurse / whoever” if the patient did in fact do so.
This. In addition to the fact that everything you write is discover-able, you have to just state facts. Saying a patient was agitated is better than belligerent. One is an observation, the other is an opinion. And if a patient told you to “go f yourself” you would put it in quotes, using the same verbiage the patient used. You are to report facts, not necessarily interpret them. “Pt was tearful” is a description of what you see.
