Threatening to Sue is NOT the Answer

We are a fairly litigious society nowadays, and the threat of lawsuits in healthcare is very real. People's lives are on the line and healthcare professionals are entrusted to both make the quality of life better and cure or manage disease and injuries. This is not an easy task, and most providers and staff take this extremely seriously and are under a great deal of stress. In addition, every licensed professional is regulated by a board of governors in some respect (Nursing Boards, Boards of Medical Examiners, etc.).

When a patient threatens to sue a provider or staff over issues, typically the patient will be on the losing end. I'm not saying that malpractice does not happen, and I'm not saying that those patients don't deserve compensation for wrong-doings. What I am saying is that a great many people threaten to sue for the reason that they think they know better than the doctors. Doctors are not infallible, however their schooling, clinical training, and residency given them more knowledge than most laymen can find on the internet.

Threatening to sue professional healthcare providers for not prescribing the medication you want is a fool's errand. This is the most common issue I've heard for people threatening to sue, and frankly it makes no sense. There are multiple ways to manage pain, and recent evidence shows that opiates are not necessarily the best route for pain management. Some people will benefit from opiates, most would benefit more from exercise or physical therapy. Simply put, suing because you want pain medication will not get you the medication and damages your relationship with a provider that is trying to help you. Also, just because your old provider prescribed the medication does not mean that a new provider will. Providers practice differently and come at issues from different points of view. Threatening to sue your new provider because your old provider gave you medication is not the right answer.

I want to be clear that some lawsuits are warranted, and patients should not lose sight of the fact that some providers are not great.

The point I want to emphasize is to talk to your provider / healthcare team. Have the conversation and be prepared to accept a hard truth that the provider may know more than you, and be prepared also to ask for a second opinion if you feel that you're not getting the best care. Most providers are happy to refer you to another provider once you've at least tried their recommendation. Communication is the key to getting the best result. If your provider is unwilling to answer questions consider another provider.

Threatening to sue does not solve the problem, and typically will not get the result that the patient is looking for. Communication and courage when discussing your care with your healthcare team is the answer.

Great Cause

Starved for Attention
www.starvedforattention.org
Doctors Without Borders/Médecins Sans Frontières (MSF) and VII present Starved for Attention, a multimedia campaign exposing the neglected crisis of childhood malnutrition.

http://www.starvedforattention.org/take-action.php

Healthcare Tip

Here's a quick tip for understanding healthcare:

You as a patient are both a human being to us, and also a number to us. I say this so that people understand that there are two ways healthcare professionals look at people. For example, most hospitals and clinics use some sort of metrics to determine their performance in comparison with themselves or neighboring facilities. In doing this we take the human element out and review that we are off target by XX patients. The main purpose of this is to ensure that we provide the best possible care to people though, thus returning to the human element.

Here's a true example: We monitor HEDIS metrics for all of our patients. One metric revolves around which drugs to prescribe for elderly patients, as some drugs are more harmful or less tolerable to elderly patients. We had a lady walk into the clinic just fine, but by the time she made it to the exam room, it was apparent that something was wrong. She stopped breathing, and by the swift actions of the MA and RNs on my team, we saved her life. What does this have to do with HEDIS metrics and drugs? Well, this lady was overdosed by her daughter accidentally because she was coming into the clinic for an MRI, and the daughter wanted to be sure that she was comfortable and pain free. In doing this, the daughter gave her an extra pain killer. Obviously this could have ended very differently, but again, swift action saved the patient's life. This type of situation is what calls out why we monitor the drugs that people take to eliminate or greatly reduce these types of incidents. In this case, the patient was both saved, and should never have needed to be.

So, the next time you get a call to remind you that you need a screening, blood work, or an imaging study, please take heed. You may feel like just a number that day, but it is for the purpose of making sure you as a person get the best possible care.

Drug Treatment in the Elderly (Disease Management in the Elderly)
Drugs and the Elderly: Perspectives in Geriatric Clinical Pharmacology

Healthcare Jobs

I get a lot of questions on what different staff do and who they are. I've tried to provide a brief overview below.

An MA is a medical assistant with about 6 months of schooling. These staff typically room and discharge patients, take vitals, and do general office work for their provider. An LPN (licensed practical nurse) is in between an RN and an MA in skill level and can do some nursing functions with care plans from RNs or from protocols. They get about a year of schooling and can also do anything an MA can. An RN is a registered nurse who can operate under the verbal orders of a provider, operate outside of protocols as necessary within their scope, and use more critical thinking skills. The minimum education is about 2 years.

I use the term provider to describe physicians and allied health (nurse practitioners (NPs) or physician assistants (PAs)). Physicians are skilled at a high level and can have their own practices under their own license. Allied health staff are also highly skilled, and can do almost anything a physician can with limits and differences. There are two main differences between a PA and an NP: 1. An NP has to have been a registered nurse at some point. Some people go straight from nursing school to get a bachelor's an then on to an NP, but at some point in there the nurse had to become registered. 2. An NP can practice on their own, while a PA must practice under the license of a physician.

I hope that gives you a good overview. This is not to be all inclusive, but generally helpful information.

Healthcare Reform

Healthcare reform will reward providers that manage and coordinate services more cost effectively while improving quality of care. I think this is an interesting point. As we deal with the healthcare reform changes, consumers should become more aware of the interactions with providers and the healthcare system. Costs should be tied to need, in that, we should be able to charge people for the cost of a procedure if they insist on it regardless of medical effectiveness. The more people have to pay for the over-use of care that they demand, the less they will demand it. Patients and the medical community should be shifting our focus to maintenance of care and preventive medicine, not necessarily the latest and greatest surgeries and miracle pills.

There are five chronic diseases / conditions that account for the majority of healthcare costs. I see nothing in reform that addresses controlling these five issues. Diabetes, Coronary Artery Disease, Depression, Congestive Heart Failure, and Asthma constitute the majority of all healthcare spending in the US (Halvorson, 2007). We have made an important step in recognizing the need for change, however, the change we landed on does not get us to long term stability. We must change the way we pay for care, and we must focus on preventing disease and maintaining care. I recommend reading George's book, its a good overview of the whole situation, and it provides some great data. I don't agree with everything in the book, but it gives you great information to start from.

Realistic Expectations

I had a patient come into my office in the clinic today demanding to be seen for an emergent issue. I thought that this member was having chest pain or shortness of breath and we may need to get an ambulance. She was yelling for someone to come help her, so naturally I thought it was a serious issue. She was constipated. She had been for two days. She called in and left a message for our RN advice line three hours before and felt it was unreasonable to have waited so long, so she came in. Unfortunately, my staff were dealing with patients in need of medical advice for lacerations, radiating chest pain, and sever abdominal cramping (to name a few) and were unable to call this patient back.

A realistic expectation when obtaining healthcare is crucial to ensure that you get what you need, and you are also not over-reacting to different medical conditions. When you have a major medical issue, you want your healthcare team to be able to respond. We cannot do that if you call for two day old constipation or a stubbed toe, so please be reasonable in utilizing our medical resources.

Please note that I am not trying to give medical advice here and that there are many co-morbidities that may make constipation a more serious issue. Those should be discussed with your doctor. My point is that most people know if they have a co-morbidity that would make constipation more serious than a person who has not had enough fiber.

Best Hospitals 2010-11: the Honor Roll

Best Hospitals 2010-11: the Honor Roll