Stalking doctors in the hospital: A patient shares her frustration
“I understand that what with juggling office hours and visits to hospitalized patients, doctors have demanding schedules. But do they understand that when your loved one is in the hospital, the rest of your life doesn’t just go away? Hospitals operate on the premise that we, the family, must make ourselves readily accessible to the doctor – not by phone but in person – —or else the doctor is not accountable.
Any time you are not in the patient’s room (and, indeed, the hospital prefers that you not linger there), it is assumed that you are in the waiting room. When the doctor arrives, the nurse calls to let you know. If you’ve stepped out to grab something to eat, make phone calls with some degree of privacy or dash home to feed kids or pets, there’s a good chance you’ll miss the doctor unless you’ve networked with others who are waiting and they are able to summon you quickly.”
I can sympathize with the patient’s frustration. Especially in the intensive care setting, any patient can have up to 5 or more specialists following, each of them only comfortable with their specific organ system. The primary care physician, hospitalist, or intensivist should be the “overseer” unifying the specialists’ recommendations.
Communication with the physician can be frustrating as well. From my end, I am rounding on up to 15 patients in the hospital, often from 6am to 10am. Then off to the clinic to see 15 to 20 patients in the afternoon. So, there are a lot of things on the plate. If a patient wants to speak to me personally, I give a time window (”I’m available between 8am and 9am for a meeting”) – similar to a cable TV serviceperson. Setting meeting times that is convenient for the patient’s family simply isn’t feasible when a physician is responsible for 30+ patients during the day, both in the clinic and hospital.
The solution? Well, I’d be open to suggestions. Clear family communication is paramount for any hospitalized patient – and can be difficult with so many things impeding this goal.
Related posts:
- Are patients refusing doctors who no longer do hospital work?
- Discharge instructions
- The waiting room: Drug reps add to the tension
- Does telemedicine reduce malpractice risk?
- "Dial-a-doc" in trouble
- Medical home
- Designing a physician waiting room
{ 35 comments }
I can sympathize. I am surprised that the doctors won’t take phone calls, though. I am an early riser – I make my hospital rounds early in the morning. I know that I will probably miss some visitors and family members, so I do the following:
1. For Adult patients who are alert and oriented, I explain everything I can, and give them the office phone number (or my card) so that a family member (only one, who should be designated by the patient) can call to discuss the case with me. I always return those phone calls.
2. For minors or adults who lack capacity to understand or make decisions, I call the family myself (at an appropriate time during the day) to speak with them or leave a message to call me back to discuss the progress.
It’s important for doctors to comunicate with family members so they don’t feel helpless, as the lady in this story did. Conversely, family members should designate a single contact person to communicate with the doctor, so that the communication can be efficient and thorough.
Why do doctors never write anything down? When is the last time you left the doctor’s office with anything but a receipt for the copay? Not everyone has a memory for a string of oral instructions, as recent studies on learning styles shows, and the effect can only be magnified when one is ill, in pain and worried about self or family member. So for the ‘adult patients who are alert and oriented, I explain everything I can….’ but how much of it sticks? Not a lot, I’d guess.
This is about hospitalized patients. Do you expect a written dissertation to be handed to you each day of a 5 day hospital stay?
No – Each day I explain your progress – you ask “How am I doing?” and I tell you. When you do leave, you get written instructions about what to eat, where to go, how to clean your wounds, and what medications to take. Not to mention when to see me agan, when to see the consultant in his/her office, and what follow-up tests to do, where and when to do them.
The article and the piece above are both about hospitalization, not the doctor’s office – I guess written words don’t stick much with you either.
Why do PATIENTS never write anything down? When is the last time you left the doctor’s office with anything but a receipt for the copay? Not everyone has a memory for a string of oral instructions, as recent studies on learning styles shows, and the effect can only be magnified when one is ill, in pain and worried about self or family member. So for the ‘adult patients who are alert and oriented, I explain everything I can….’ but how much of it sticks? Not a lot, I’d guess.
Take some responsibility for your needs. I do have some patients who come in with a written list of their concerns, and I’m happy to go down the list and answer them. Much better than the more common “Oh, by the way doc…” scenario as I am leaving the room, or the patient who tries to flag me down as I am entering the next room. If you find yourself not remembering what you are told, write it down yourself. You can’t read your doctor’s writing anyway.
As to inpatient communication problems, the purpose of hte hospitalization is for the doctor to evaluate and treat the patient, not to engage in chats with other family members. Even before HIPAA, there were privacy concerns about who to talk to and how much detail to go into. If the patient is conscious and competent, she is the only one I talk to, and she can invite spouse/friend/other into the discussion if she wants. If patient is seriously ill and not competent, I speak in generalities about why the situation is serious, about how the antibiotics the patient needs have to be given cautiously because of concern about renal damage, for example. The most common reason for my not talking to family members in the ICU family room is that they are out smoking when I round. I’m not going to interrupt my other clinical activities to chase them down. So sue me.
jb–
In my experience, doctors may lament the lack of patient information retention only to the degree that it does not cost them. I generally bring a tape recorder to all doctor interactions, for the ostensible reason that I like to remember what doctors say. And, for the reason, that as doctors often “spin” and sometimes falsify medical records, it’s better to have a “true” record of what has occurred.
Needlesstosay, I have walked out of many doctors offices.
And, for the reason, that as doctors often “spin” and sometimes falsify medical records, it’s better to have a “true” record of what has occurred.
Wow. Often? Why do you go at all? If you have so much distrust for their behavior, how can you trust their advice?
One “trusts” any service provider only to the extent that sub-standard performance will hurt them, i.e., lower their compensation/create costly hassles (like lawsuits).
By taperecording medical providers, one simply increases the possibility that sub-standard care will cost them.
By taperecording medical providers, one simply increases the possibility that sub-standard care will cost them.
So then it’s not about improving the quality of the medical advice or the care provided, it’s just about increasing the opportunity for recovery in case of a lawsuit?
I feel sorry for you that you are more concerned about your affect on the physicians earning potential (or the cost to him/her of substandard care) than you are about receieving high quality care for yourself.
Do you really believe that a physician will alter their advice or treatment because a tape recorder is in the room? Rather than hoping for an opportunity to play your tape in court, find a new physician.
rich, md.:
You’re wrong on all accounts.If doctors know they might be completely accountable for what they say, I think they’d be more careful and thoughtful in their analyses. That’s perfectly reasonable. Similarly, I also believe that patients should have the option of having surgeries/ their entire medical stays videotaped.
“I feel sorry for you that you are more concerned about your affect on the physicians earning potential (or the cost to him/her of substandard care) than you are about receieving high quality care for yourself.”
You’re pity is touching, but misplaced. I’m not dying to get into a medmal suit; I want to avoid medical error. Increasing the costs of error is a good way to discourage it.
“Do you really believe that a physician will alter their advice or treatment because a tape recorder is in the room?”
Well, yes. Many doctors and at least one hospital administator object to my taperecorders and in the case of the hospital my portable video-cam. If it makes no difference, why would they object?
Interesting. I already assume I am accountable for everything I say – perhaps that why this strikes me as odd. I have no objection to taperecording per se, though I do understand a hospitals objection to videotaping.
I would respond to you similar to advice I give many patients:
If a doctor refuses to allow you to get a second opinion, you need a third opinion.
If your doctor has a problem with audiotape, you need a new one.
But I take exception with your statement that “doctors often ’spin’…” – that’s just as accurate as “patients often sue.” It also strikes me as odd that a physician would choose to give you poor advice unless it costs her too much – as if it takes more effort to give good advice? Do physicians make economic decisions about the value of the advice they give? (Hmmm.. you should ignore that chest pain – oh wait, you have a tape recorder – better get an ECG)
rich, md,
“I already assume I am accountable for everything I say – perhaps that why this strikes me as odd.”
Most people–including doctors–are self-interested wealth maximizers. If they face a price for error, they will make fewer errors. Of course, as La Rochefoucault would say, “We judge ourselves by our intentions, not our actions”
“I have no objection to taperecording per se, though I do understand a hospitals objection to videotaping.”
Why? I’m quite curious.
“But I take exception with your statement that “doctors often ’spin’…” – that’s just as accurate as “patients often sue.”"
It’s admitted to on the medblogs, and I’ve seen it myself.”
“It also strikes me as odd that a physician would choose to give you poor advice unless it costs her too much – as if it takes more effort to give good advice?”
Of course, it take more effort to give good advice. My analysis, more thought, more effort.
It’s admitted to on the medblogs, and I’ve seen it myself.
Then of course it must be the status quo. You have elevated unqualified generalization to an artform.
uh,no. Given HIPAA and given the cost of actually conducting studies, do you really expect good research on the accuracy or spin-quotient of medical records? It happens I feel relatively confident–particularly because medical providers have a high incentive to do so–and low risk of sanction; therefore, low cost ways of protecting oneself, like tape recording, is perfectly reasonable.
btw, why do you object to videotapping in hospitals? Just curious.
Whose spinning now? I did not say I objected to videotaping. I wrote that I understood a hospitals objection. So much for an accurate, written, indisputable record being misinterpreted. I think you have illustrated the point beautifully. My impression about the objection to video is that, for example, video only looks in one direction, and partial facial expressions, partial surgical maneuvers, fine details that are obscured, etc. may easily be misinterpreted. Far more easily than misinterpreting the typed word a short way up the page. Audio, on the other hand, captures just about all of the audio, if the recording is any good. In is largely omni-directional, and the record is less likely to be misrepresentative.
As it happens, there are many studies about the accuracy of medical records documentation. HIPAA has nothing to do with it.
Forgive my misattribution and thank you for your explanation re: videotaping.
BTW, any cites to the studies on medical record accuracy? Thanks.
You can start by searching pubmed (pubmed.com) for “doctor patient communication” – I am sure there are other queries that may give more results.
In response to anonymous who said,”Most people–including doctors–are self-interested wealth maximizers. If they face a price for error, they will make fewer errors.” I think that’s a sad way to view people. There are good and bad in any profession and the medical field is no different. I, myself, have been involved in reporting a doc that did something unethical and illegal to the medical board – but simply because I’ve had one bad doc doesn’t mean they should all be viewed as unethical or that I should now hate all doctors. I have relatives who are alive because of the extraordinary skill & care provided by great medical staff. And incidentally, what is wrong with a doctor making money???? As far as I’m concerned they worked their asses off in school and deserve every penny they get and then some.
It would not surprise me if someone who routinely brings tape recorders or video cameras to doctors visits, blatantly displaying his distrust, didn’t actually receive poorer care because of the doctors aversion to the patient, and perhaps because people who second guess themselves (his or her physicians) usually make poor decisions. (See Malcolm Gladwell’s Blink).
We often talk about videotaping patients in the Emergency Room….so they can see how they behaved when they are sober several weeks later. I wish I could have videotaped the patient who broke my nose, I wish I could have videotaped the stoned woman on Crack with HIV and Hep C whose needle I got stuck with and ended up causing me to be on HIV meds for 6 months. I wish we could have videotaped the guy who threw an uppercut at a cute blond nurse I work with and broke her jaw. In court they just laugh at us when we press charges: “He was drunk, what do you expect?” Then these same patients come back and we have to take care of them. Where is security, you ask? We can’t afford security, all our money goes into things like “risk management”, because patients like you are trying to win the lottery by taping doctors.
And tape record yourself so it can be replayed to the spouse, girlfiend, boss, pastor, son, then daughter, then brother Jeb, then cousin Vinny — after you explained everything to the competent patient
Response way back up the chain of messages: why don’t I write stuff down that the doc is telling me (in patient or out)?
Because he’s talking so fast as he skates out the door that I can’t process what he’s saying quickly enough to ask questions much less make notes on it. And FYI I’m not exactly some dodo who can’t manage note taking and thinking at the same time in a reasonable situation. I’ve got two graduate degrees and use my brain to make a living every day, AND I read up on medical literature to be familiar with whatever ailment I’ve got so I can follow along with the music.
Lack of effective communication with patients is poor medical care, and pretty par for the course, just as Rich MD’s attitude shows. It’s not HIS problem, it’s MINE. In all senses of the phrase.
Rich, I’m glad you’re not my doctor. I’ve been watching your comments over time, and while you present yourself as Dr Welby, you’ve got a condescending edge to you that is a tad scary. You want to be a good doctor in all respects, I’m sure, but there’s an attitudinal thing there….
“It’s admitted to on the medblogs, and I’ve seen it myself.”
Well then case closed, particularly if a superdoc like our own Dr. Elliot tells us so.
“Rich, I’m glad you’re not my doctor.”
Dude, I’m glad you are not my doctor’s patient. It’s obnoxious know-it-all a**holes like yourself who drive the good docs out there nuts.
Anon 117 –
Please point out where my “attitude” shows that poor communication is “par for the course.” I really want to know, because if you believe that from what I wrote, then I failed to communicate something well, and I want to fix it. I happen to think communication is important, as I wrote, I DO provide written instructions, call family members, etc. I’ve never said or written that it “wasn’t [my] problem.”
I am not Dr. Welby, and I am not sure what I have written that is condescending, but I would appreciate it if you could point it out. Like many others who post, I try to be honest, and I disagree with people from time-to-time, and when people take my words out of context to make an argument against what I say, I point it out. The fact that I am a physician doesn’t change the fact that I might be opinionated.
“I’ve got two graduate degrees and use my brain to make a living every day”
You need to mention this when you say you think Rich is condescending? I’m picturing you in my ER, with your pathetic little tape recorder, the 2 docs on duty fighting to do whatever they can not to be the one forced to see you. What the hell did I do wrong to deserve getting into this profession? Can it get any more painful? I feel like I need a Lawyer consult twice as often as I need a surgery consult, or a neurology consult. I would take a 50% pay cut to work without all the daily fear of litigation. The best word to describe medicine today is “ANTAGONISTIC”. Whose fault is that?
We had a patient who came in once with a camera AND a Tape recorder. Started taking pictures of the toilet. Said he was a secret agent for the CIA. Ended up in four point restraints in the corner.
The docs in Houston are pure evil. Why many of them even volunteer their time at homeless health care clinics! And don’t get me started about Doctors Without Borders… Evil, money hungry docs!
I think rich, md is not only condescending and rude but appears, from his writing, to demonstrate a pathological narcissism that I fear might endanger his patients. Consider this exchange:
A commenter (1.30 PM)asks if there is any research on the degree to which doctors falsify or spin medical records.
rich, md at first vehemently resists the possibility that doctors routinely spin their records (9.57 am)and claims that there is plenty of research on the issue. However, when pressed, he simply refers to medical pubs search engige and snidely disputes the commenters (correct) assertion that HIPAA would increase the cost of such research.
Obviously, rich, md has no idea about whether reseach exists to support his point. I spent some time researching the topic and while there is plenty on the accuracy of medical records, I found nothing on his point: on whether doctors employ anti-litigation “spin” or falsification in medical records. If anyone has any insight or cites, I’d appreciate it.
The relevant point here, however, is rich md’s presumption of knowledge where he had none. He knew of no research concerning the degree of falsification/spin of medical errors, yet gave the impression he did in order (of all absurd things) to try to win an internet debate. Does he do that when he gives diagnoses and prescribes medications?
Those who resist seeing doctors as wealth maximizers . . . well what can you say? Capitalist society assumes we are all so, and has done pretty well. Other societies (like the USSR) that believed differently well, have done less well.
Finally, the goal of health policy is to institute economic incentives that maximize consumer welfare. Taperecorders or videocams may do that by eliciting superior performance from medical care providers. They’ve worked in improving the performance in other jobs, like retail clothes services–so let’s give it a try!
I know, let’s all just grab our tape recorders and video cams and tape each other at all times. When I go out to eat, let me tape the waitress maybe she’ll provide better service if she sees my video cam. Quick! Grab the camera my cat needs her rabies shot! Maybe the vet won’t try and rip me off if she sees I’m taping her every move. And my minister – well I’ve heard that some of them are really swindlers and try and rip off their congregants maybe I should start taping the sermons… Come on…if you always go around thinking everyone is going to try and do you wrong what a sad way to live.
So much for asking for constructive criticism.
Cheesh, where did all this vitriol come from. All I said was why can’t docs write things down, then got bashed for being off topic (in patient vs out patient), then got called an ‘a**hole’ ‘clutching’ ‘my pathetic little tape recorder’ — hello? All I asked was why nothing gets written down, and that there’s no time to take notes because the doc is so on the fly.
I was not being condescending when explaining that I am a reasonably well educated person, because that is relevant to whether I’m able to follow instructions, take notes and understand what is going on. If I can’t keep up with what the doc is saying and take notes and ask questions at the same time, what about the folks who don’t practice those skills in their everyday jobs like I do? That was the point.
I don’t pathetically clutch my little tape recorder, but I tell you I am quite alarmed and even frightened by the attitudes I see in too many of you posting who are apparently MDs. The anger, disdain and hostility can only get in the way of the service you provide. Service?? Did I say ’service’? Golly, I did. Because that’s what it is, and I don’t know why that ticks so many of you off. You’re not manufacturing widgets, you’re dispensing advice, and that’s a service. A hostile attitude and lack of respect for your patients will only get in the way of your ability to do what you ostensibly went to medical school for: to take care of people who need you…but I’m beginning to think taking care of people is not the motivator for some of you — instead it’s to make money and wield your intellect.
Part of the problem is perhaps that the selection criteria for medical school have lots more to do with board scores and not much to do with compassion and interest in other humans and the human condition. It’s sad that the highly technical nature of medicine has skewed the med school admissions process to technicians and away from the humanists. It’s changed the interaction with doctors even in my lifetime, making it so much less an art and so much more a science.
Rich thanks for not taking offense at my comment… here’s a quote from you in this thread: “I feel sorry for you that you are more concerned about your affect on the physicians earning potential (or the cost to him/her of substandard care) than you are about receieving high quality care for yourself.” Your comment is certainly one way to interpret what was said, but edges on snide, when it wasn’t the purpose (to my reading) of the person who made the comment. It’s not a productive response from you and to me shows more of a ‘So there!!’ response than one of respect.
And another example: “The article and the piece above are both about hospitalization, not the doctor’s office – I guess written words don’t stick much with you either.” Yes, you’re right, I didn’t follow DIRECTLY on topic to the in patient comment made before, but so what? It made me think of the issue, because I’ve had the same experience as both in patient and out patient [and PS, the canned sheets the nurse hands you when you leave the hospital about eg 'wound care' is not exactly what I need when trying to understand the larger medical issues and effects and expectations about prognosis and recovery.] What’s the point of your comment that ‘written words don’t stick much with you either’? That again is kinda snotty and utterly unproductive. It might give you the feeling that you’ve played the trump card in the conversation, but you haven’t, and in fact have chilled the conversation. That’s what I mean about your attitude, and I suspect you probably do the same thing off-blog too. Reminds me of a snotty wine steward talking down to the poor slob who comes to a restaurant looking for a nice dinner and instead of being treated pleasantly is put in his place. The diner is out the cost of his meal if he goes home feeling stupid; the patient may not open up with critical information in the future if he’s just going to get put down. Just cause you’re smarter IQ-wise doesn’t mean you’re better human-wise. That’s my point. Thanks for listening.
The source of vitriol, if anyone was wondering:
“…you’ve got a condescending edge to you that is a tad scary.”
“…but there’s an attitudinal thing there…”
“…is not only condescending and rude but appears, from his writing, to demonstrate a pathological narcissism that I fear might endanger his patients.”
“…not much to do with compassion and interest in other humans and the human condition.”
“but I’m beginning to think taking care of people is not the motivator for some of you — instead it’s to make money and wield your intellect.”
“I suspect you probably do the same thing off-blog too”
…and that justifies calling me an a**hole? Get real. All those comments by anonymous weren’t mine, btw, but the same principle applies: it’s those of you medicos who hold the rest of us in contempt that scare me — if you don’t treat us with some measure of respect, how effective will your information gathering and diagnosis and treatments be? If as one of you said you would take a 50% pay cut to not have to worry etc etc, then do it!! Get out of medicine!! Go do something that doesn’t put you on the front lines despising those you are supposed to help, because (duh) when you hold a patient in contempt, you won’t do a good job.
Why stay somewhere you hate, taking ‘care’ of people you fear and dislike? It’s an honest question, and I wish some of you snarling dogs out there would get a grip and admit that it might not be so bad if you have to send out your next set of Xmas cards saying “This year Jim decided to retire from medicine and is now entering a new career as X.” You can do it! It’s a free country!
Maybe you love science, but not medicine: medicine has those pesky humans attached to it. People like me…and I have to tell you, I go out of my way to be grovelingly grateful to my doctors and nurses and admissions clerks and lab techs. It’s a very hard job they all have, and I appreciate their efforts when sincerely given. I moved cities some years ago and had to start all over assembling a team of doctors who pay attention and don’t find me just another annoying sick person. We sick people aren’t the problem, fellas, we’re the reason you went to medical school, but for those of you for whom that’s not enough to get you through the day, all I can say is: CAREER COUNSELING IS YOUR FRIEND!
And for those of you who really do love medicine and its pesky humans, maybe try some minor market research and ask patients to fill out and drop in a suggestion box anonymous comments about your office and your bedside manner. I bet you’ll learn something and be the better for it. It’s not peer review, but hey.
It seems the tone of the comments went from tense to bad to worse.
Informing patients and families about the things they need to know is a challenging and sometimes time-consuming part of medicine.
One must consider how people learn, and the difficulties of learning under stress. If an illness wasn’t bad enough, many people come into the hospital or doctor’s office with a high level of anxiety because of a previous encounter that may have been very emotionally charged (severe illness in a family member, for example).
The “mistake” that I see some doctors make is to think that they can have a meeting with a patient or family, “have it all out”, explain “everything” and be done with it. But we know that under stress especially there are limits to how much people can hear, understand, and remember. Many are lost in their own thoughts even though they appear to be listening. If a lot needs to be communicated, there should be a plan to have more than one session, and encouraging people to write questions down in betweeen, so they don’t forget and can also organize their thoughts better.
Note-taking, tape recording, etc are OK, BUT one can get focused on the process (writing or operating the equipment) and not really listen to what is being said.
At some point there does have to be some respect for the physician’s time. One of my “pet peeves” is when I have spent a long time with one family member or the patient, and then another comes up and wants the same long session — it’s the patient who truly has the right to a one-on-one session, not every single member of the family individually.
To be a physician, you must get better at this in a never-ending way. Those who don’t have the patience or the willingness should hire an assistant to help them out — it’s not an optional job.
I read with interest the comments about recording devices. I recently had a very bad experience with a doctor I have known for six years. I lost the use of my limbs because this person would not heed my complaints. When in retrospect it turned out that I was correct about my medical condition this person falsified my medical records in an attempt to place the blame on me. The last two visits I had with him were very strange and he kept talking about malpractice which had nothing to do with me or my needs. I have had over thirty surgeries the last few years so I’m not a novice to the medical profession.When I asked for my medical records I was told that he had to dictate them and his dictation was all I was given. Every word was slanted to portray me as unstable though he was the one raging at me as I sat in his office postsurgical with braces etc.I had to use a portable recorder during this time because I didn’t have use of my arms. It clicked on when he was screaming at me for having had surgery telling me I was not going to ruin his name in the community. I was there for head pain which went untreated and then he blocked a referral he had made for physical therapy. If he knew that his tantrum had been recorded he would really have something to complain about especially in lieu of his debasing remarks towards me that the tape show aren’t true. I don’t know why he is acting this way. As far as I can see he has never been sued. I think it has more to do with him seeing 45 patients in an 8 hour span per day as his staff admitted. Yet I still need my medical records fixed or else his negativity and false claims will follow me forever. The only alternative I have is to report him but then what he said will come true. It’s too weird. I believe doctor’s are human and hence err but when they refuse to admit it and try to place blame on the patient by casting dispersions and falsifying medical records there must be some recourse short of lawsuits.
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