Why this doctor moved to private practice

Chief of Medicine
Evanston Hospital
October 23, 2005

To whom it may concern,

I would like to take a moment to express my deep displeasure with one of the interactions I had with a physician in the Church Street location. I use the term “interaction” loosely since the doctor in question, Dr. Jordan, never actually saw me. Apparently he was too busy.

Last Thursday I was shopping in downtown Evanston when I felt the sudden onset of severe abdominal cramps. I ran into the nearest restaurant and spent the next thirty minutes on the toilet. After finishing I felt much better and packed up to leave. As I exited the restaurant, I noticed your clinic across the street.

Thinking that this was my lucky day, I entered the waiting room and asked for an appointment. Since this was my first time in the office, I was asked to fill out numerous forms. A few minutes later a nurse brought me back to an exam room.

She asked a lot of questions about my diarrhea and abdominal pain and then examined me. She then left the room for a few minutes. When she returned she explained that Dr. Jordan was the only doctor in the office and currently seeing other patients. The nurse made up some excuse about another doctor calling in sick. He could see me but it would have to be at the end of the day.

My jaw dropped. That would be like four hours later. Why couldn’t I see him immediately? The nurse explained that she had evaluated me and my vitals signs were stable. She said my abdominal exam was normal. She then tried to shoo me away by saying that most diarrhea is self limited.

By now I was quite angry. I demanded that the nurse at least give me an antibiotic before I left. I could be dead by the the end of the day. The nurse left the room yet again and returned a few minutes later. Apparently Dr. Jordan felt that antibiotics are not usually indicated for most forms of diarrhea and he would prefer to examine me himself before he made that decision.

I stormed out of the clinic with my mind made up never to return to one of your facilities again. When I got home I took some amoxicillin which was left over from my root canal. I felt better within minutes.

I am lucky I had the antibiotic in the cabinet or I could have become very sick. I believe Dr. Jordan is a horrible physician and he brings down the quality of care that you are trying to provide. I hope you work to correct his attitude!

Sincerely,

Disappointed Customer

Written in neat cursive on the side of the letter was a note from an administrator:

“Dr. Grumet. Can you please call this patient and apologize. We definitely handled this one wrong.”

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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  • Anonymous

    The patient certainly shouldn’t have been given antibiotics, but why after having a nurse examine her, did anyone hallucinate having her come back in 4 hours?  She could be asked to wait in the  waiting room, or more importantly  told upfront that this was the waiting time,after triage  and that she could always go the the ER if she felt that ill, but that would cost her an x dollar copay vs the wait.
    This  case  required what I call “verbal valium”- a discussion about the risks of antibiotics, the risk of drug  resistance, and verbal valium. The intake was a significant part of the problem, poor staffing, and an unreasonable patient.
    But apologize? It depends on who runs, staffs  manages the clinic.

    • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

      i love that term verbal valium….it really does describe so much of what we do these days, 

  • Anonymous

    So, let’s get this straight:

    * Patient enters practice for cramps and diarrhea
    * Even though patient is stable, she demands to jump to the head of the line. Tough luck for all the other sick folks ahead of her, she wants to be seen IMMEDIATELY
    * Patient demands an antibiotic, and is furious when a Doctor who hasn’t even seen her yet and is up to his ass in other patients won’t just prescribe her one sight-unseen
    * Patient storms out, self-medicates with an antibiotic that they had left over because they didn’t take it correctly for what it was prescribed for
    * Patient writes a howler

    Handled wrong, yes, but not by the Doctor. In this toxic “the customer is always right” environment we live in, entitled know-it-all patients like that are becoming more and more common, and the Doctor isn’t the one in need of an attitude adjustment. Patients like that are not anyone you want in your practice, and one can only hope she keeps her promise of never coming back.

    • http://www.facebook.com/people/Wayne-Stoutenger/100000605364027 Wayne Stoutenger

      Responsible organizations no longer follow “the customer is always right” dictum.  Some customers one is better off sending to your competition.

  • http://pulse.yahoo.com/_PXMZT4C2GJBG54DFLARA5GCIB4 kevin windisch

    it is letters like this that make me want to leave medicine.  She complains about all the forms- some are required b y the government, others by the courts, others still by her insurer… Like the forms are your fault.

    She has diarrhea but can’t wait to be seen.  Go to the er, see what the wait there is like (for your 1,500$ er fee).

    She demands antibiotics… That will only make your diarrhea worse.  Unless of course, she wants c. dif with its 20% mortality rate.

    The doctor did all the right things by triaging her and offering to see her yet she is writing him nasty notes and most likely flaming her on the internet.

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    well the main issue the doctor never saw the patient, no matter how much medicine advances you still need to see people, this visit would have taken 5 minutes the lady would have been fine. One of the primary care doctors main objective these days is to make sense of all the information out there that patients have access to but don’t neccesarily understand.  I totally feel for the doctor having have a letter from some administrator, its one of the reasons I went into private practice to never have that happen to me. Good thing the patient had that amoxicillin or she would have died…lol

    • http://www.facebook.com/profile.php?id=1052074130 Kevin Windisch

      It would NOT have taken 5 minutes.  It would have taken 30 minutes of explaining why she did not need the antibiotics that she was so sure she needed, in the mean time, other sick patients would have been kept waiting.

  • Anonymous

    This was handled inappropriately. The administrator should have immediately dealt with this patients diarrhea. 

    • http://twitter.com/#!/CloseCall_MD Close Call

      I sense a plot twist.  The administrator is really…. the patient!

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        No, the administrator is the diarrhea.

  • Anonymous

    Assuming this is a true letter really written by an unreasonable patient with vexing administrative commentary …

    Think now of how much time the busy doc subsequently had to spend in the administrator’s office justifying himself … and of how many patients he could have seen instead of doing that. 

    If only that was the only non-clinical intrusion he had to endure.  A thousand fingers are now in the clinical pie.  Makes concierge medicine look pretty good.

    Docs make better administrators than vice versa.  However, economies of scale, innumerable regulations ,and third party payer requirements make it less and less feasible for docs to do the administration.  Unfortunately, the longer administrative positions exist, the more those who fill them feel empowered to armchair quarterback the worker in the trenches who pays their salaries.

  • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

    But wait, doesn’t everything work better if we “trust the market?”

    I’m a PCP and must endure similar indignities as the author so I’m being sly- please no need for flameouts-just saying we should be wary of politicians who say markets/competition is the way to better healthcare in the US.

    • http://www.facebook.com/people/Wayne-Stoutenger/100000605364027 Wayne Stoutenger

      Actually, trust in the market works very well.  This Dr was much better off shut of this patient, and he was much better off out of an organization as foolish to attend to this persons whims.  The market actually works very well and to everyone’s benefit.  Read “I, pencil”.  It was written in the ’50s but so applicable today.

      http://www.fee.org/pdf/books/I,%20Pencil%202006.pdf

  • Benjamin Wiens

    This shouldn’t be a platform for finger-pointing and resolving somebody’s frustration through a one-sided letter. It would be interesting to hear the other side.

    • Anonymous

      My understanding is that Dr. Grumet left for private practice because of what the practice administrator did (forwarded the letter to him requesting an apology) rather than the letter itself.

    • Terry M

      I agree.   We’ve seen the patient’s viewpoint.  I’d be interested in hearing Dr. Grumet’s viewpoint now.  :)

  • ellendastork

    I don’t believe this Dr’s letter needs further info or clarification. I had a similar incidence at the hospital I worked at, and it happened to be a staff member’s entitled daughter who I made upset, and not only was I asked to apologize, but the patient’s letter was read to the entire medical staff at a General Medical Staff meeting (the 1st time this had happened in my 10 yrs. on this hospital’s staff) and used as an example of why some patients were going to the rival hospital. Not only was this my only known complaint in 20 yrs. of practice, but I was the 2nd highest biller for this hospital, and I was the recent Chairperson of the Surgery Dept. By the way, the last time I took Amoxicillin, it GAVE me diarrhea!

  • http://www.facebook.com/profile.php?id=100002934866034 PJ Dew

    She felt better “within minutes of taking the Amoxicillin”????  That is some wonder drug!!  Can we all say “placebo effect”?  Diarrhea most of the time is not an urgent matter.  If you go to a walk-in clinic, you should expect to wait.  He didn’t say he wouldn’t see her.  He couldn’t see her until later.  She was certainly not an urgent case.  Why did she go to the doctor for diarrhea anyway? We all get it from time to time and cramping comes with it.  Why did she have Amoxicillin left over???  Clearly, she does not follow her doctor’s orders, as she did not finish the course of ABX.  This woman sounds like a hypochondriac and she should be apologizing to the doctor!!

  • Anonymous

    Where does it say that the patient is a woman?

    • http://twitter.com/HurricaneAlice Alice Mary Muhleisen

      I thought the same thing.  I’m hoping all these commenters are just being gender-neutral, and not assuming that the whiney patient must have been a woman.