March 9th, 2007 by Dr. Val Jones in True Stories
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In my last post I described how VIPs don’t necessarily get better medical care. In this post I will describe a case study of a bully whose behavior wasted endless resources and time. This is a true story.
The son of a business tycoon experienced some diarrhea. He went to his local emergency room immediately, explaining to the staff who his father was, and that he required immediate treatment.
Because of his father’s influence, the man was indeed seen immediately. The physicians soon realized, however, that there was nothing emergent about this man’s complaints. After several blood tests and a stool sample were taken, he was administered some oral fluids and monitored for several hours, they chose to release him to recover from his gastroenteritis (stomach flu) at home.
The man complained bitterly and said that he wanted to be admitted to the hospital. The physicians, with respect, explained that he didn’t show any signs of dehydration, that he had no fever, his diarrhea was indeed fairly mild (he had only gone to the restroom once during the hours of his ED visit – and that was when he was asked to produce a stool sample). The man’s pulse was in the 70’s and he had no acute abdominal tenderness.
The man left in a huff, and called his father to reign down sulfur on the ED that wouldn’t admit him.
And his father did just that.
Soon every physician in the chain of command, from the attending who treated him in the ED right up to the hospital’s medical chief of staff had received an ear full. Idle threats of litigation were thrown about, and vague references to cutting key financial support to the hospital made its way to the ear of the hospital CEO.
The hospital CEO appeared in the ED in person, all red and huffing, quite convinced that the physicians were “unreasonable” and showed “poor judgment.” Arguments to the contrary were not acceptable, and the physicians were told that they would admit this man immediately.
The triumphant young man returned to the ED for his admission. Since the admitting diagnosis was supposedly dehydration, a nurse was asked to place an IV line. The man was speaking so animatedly on his cell phone, boasting to a friend about how the doctors wouldn’t admit him to the hospital so his dad had to make them see the light, that he moved his other arm just at the point when the nurse was inserting the IV needle. Of course, the poor woman missed his vein.
And so the man flew into a rage, calling her incompetent, cursing the hospital, and refusing to allow her to try again.
At this point, the ED physicians just wanted him out of the emergency room – so they admitted him to medicine’s service with the following pieces of information on his chart:
Admit for bowel rest. Patient complaining of diarrhea. Blood pressure 120/80, pulse 72, temperature 98.5, no abdominal tenderness, no white count, patient refusing IV hydration.
Now, this is code for: this admission is total BS. Any doctor reading these facts knows that the patient is perfectly fine and is being admitted for non-health related reasons. With normal vital signs, and no evidence of dehydration or infection, this hardly qualifies as a legitimate reason to take up space in a hospital bed. And when the patient is refusing the only treatment that might plausibly treat him, you know you’re in for trouble.
The man was discharged the next day, after undergoing (at his insistence) an abdominal CAT scan, a GI consult, an ultrasound of his gallbladder, and a blood culture. His total hospital fee was about $8,000.
Do you think he paid out of pocket for this? No. He submitted the claim for payment to his insurance company. Their medical director, of course, reviewed the hospital chart and realized that the man had no indication for admission, and refused medical care to boot, so he denied the claim.
So the son appealed to his father, who then rained down sulfur on the insurance company, threatening to pull his entire business (with its thousands of workers insured by them) from the company if they didn’t pay his son’s claim.
The medical director at the insurance company dug in his heels on principle, assuming that if he continued to deny the claim, the hospital would (eventually) agree to “eat the cost.”
In the end, the insurance company did not pay the claim. The CEO of the insurance company called the hospital CEO, explaining that it was really the doctor’s fault for admitting a man who didn’t meet admission requirements. The hospital CEO agreed to discipline the physician and eat the cost to maintain a good relationship with the insurance company that generally pays the hospital in a timely manner for a large number of patient services.
I ask you, my friends, does this seem fair? It’s because of these cases that doctors become (sadly) hard of hearing when it comes to patients who appear well, but may indeed have a serious condition.
In my next post, I will describe a true story of a baby whose life was saved because of her mother’s insistence.
P.S. There are many comments on this post, featured at Kevin MD.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 9th, 2007 by Dr. Val Jones in Opinion, True Stories
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People often believe that the medical treatment that VIPs get is far superior to the care received by “common folk.” While it’s true that a VIP might get a nicer hospital room, the care received might actually be inferior.
Why? Because all of the anxiety and pressure to perform all possible tests to rule out all possible problems results in higher risk to the patient. Most tests are associated with some degree of risk – catheter infections, phlebitis, dye alleries, anesthetic reactions, and so on. Though these risks may be small, they are additive.
Beyond the risk of unnecessary tests, is the risk of unnecessary medications. When a VIP complains of an issue, he may get additional medicine. Medicine has side effects, and side effects can have serious consequences. Consider the deadly side effects of pain medicine that a dear patient of mine once had.
Then there’s the pressure that physicians feel to do what the patient requests, rather than exercising their clinical judgment.
In one particular case, a young executive came to the ER complaining of abdominal pain. The physicians ran all kinds of tests and concluded that he had a common stomach virus. The man was convinced that he had appendicitis and called in a favor from his “connection” who knew the CEO of the hospital. The hospital CEO questioned the physicians taking care of the man – whether they could say with 100% certainty that this wasn’t appendicitis. They said that it was highly unlikely, but that the only way to be 100% certain would be to remove the appendix and examine it under a microscope. The CEO asked them to take the patient to the OR. Of course, the executive did not have appendicitis. He did, however, undergo an unnecessary surgery, which his insurance company paid for in full, contributing to potential increased premiums for the others in his company’s group. Did this VIP get better care? I think not.
In my next post I’ll discuss how one VIP bullied his way into the hospital without even being truly sick, causing all kinds of problems that dragged on for months!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 8th, 2007 by Dr. Val Jones in Opinion
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A Turkish friend of mine told me that he had saved for several years to bring his grandmother to America for a visit. His pre-teen son had met her only twice in his life (via trips to Istanbul) but they corresponded frequently and had a very close bond. My friend said he wanted to surprise his son by having his grandma at home when he came back from school on his 14th birthday. The only hesitation, my friend said, was that his mom didn’t speak any English and he was worried that she might get lost during an airplane transfer or in the airport. He worried that she would be afraid and alone.
Being in a foreign country where you don’t speak the language can be a frightening experience. When I was a teenager, I flew to Zaragoza, Spain to visit a friend of my mother’s. I felt excited at take off from the US, but as the plane approached the unfamiliar red soil of our destination, a sense of uneasiness settled in. The flight attendants started messaging in Spanish, and as we touched down I knew that I wasn’t home anymore. All I knew how to say was “hola.”
As I made my way through the airport, all the signs were in Spanish, I knew I needed to get a cab, but I wasn’t sure where to wait – and the Spaniards didn’t seem to respect queues. Once I fought my way to the front of a gaggle of natives, I realized that the cab driver needed to ask me clarifying questions about my friend’s address. I responded in English, to which he repeated his question with increased volume. I felt really stupid and quite helpless.
My experience was kind of similar to the feeling that patients have when they are thrust into a medical situation with a sudden, life threatening illness. Healthcare professionals can forget how foreign everything is to the patient, and go about their activities without explanation, or with jargon-rich “medicalese” that is virtually inscrutable to the person with the illness. When questioned, they repeat the jargon, raising their voice for emphasis and “clarity.”
Hospitals spend lots of money on translator services for foreign languages, but many healthcare professionals forget that medicine itself is a kind of unique language that requires translation. As the consumer driven healthcare movement takes wing, it will be more and more important to provide a kind of translator service for those who need to make educated decisions about their medical options. The accuracy of the translation can be a matter of life or death, and so healthcare consumers need to be very selective in where they get their information. Considering the source of your information has never been more important. Don’t let your health be lost in translation.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 7th, 2007 by Dr. Val Jones in True Stories
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Girl scout cookie season is upon us, and recently our office was swarming with youngsters taking cookie orders. I wasn’t sure which girl I should order from (one can’t really order from each of them and expect to maintain any semblance of a normal BMI) and as I was considering how to choose, one energetic little girl simply walked right up to me and asked if I’d like some cookies.
She was slim and blonde, with bright eyes and an honest face. I knew the “sales pitch” didn’t come naturally to her, and I tried to make it easier by joking a bit. She was shy, but on a mission. I asked her which type of cookie she liked best, and if her daddy ate too many of them. She was innocently pleased with the interaction and disappeared down a hallway near some cubicles.
Many weeks later a large delivery of girl scout cookies arrived. There was a mass distribution strategy in place with moms and girls cutting open cardboard boxes of cookies and delivering them to buyers. I asked if my cookies were on the list. They told me that they didn’t sell me the cookies, so I’d need to wait for the specific little girl who sold them to me to stop by.
About a week later, when I had assumed that my little girl scout had forgotten about my order (and the rest of our staff had well and truly gorged themselves on thin mints), her dad came into my office with a pretty bag tied with a ribbon and a hand written card from his daughter. He told me she asked him to deliver it personally, because she wanted her service to be different than the other girls. Her dad joked that he was trying to train her about “differentiators” but I was quite touched by the effort she had made to make me feel like a special customer.
Later that afternoon I sat down to write a thank-you card to the girl. I wanted her to know that her efforts made a difference, and that I noticed her hard work in making my cookie purchase a personalized experience (not just part of a bulk delivery service). I put some stickers on the card, I used colorful paper, and a big red envelope.
A few days later I asked her dad if she liked the card. This is what he wrote to me:
“She loved it. She saw it at breakfast and came screaming upstairs to show it to everybody. Thanks!”
That really made my day. I hope in some way that I’ve encouraged this little girl to continue to reach for excellence, to stand out in the crowd, and to know that her work is appreciated. It is this sort of attitude toward life that will help her grow up to be… a revolutionary.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2007 by Dr. Val Jones in News
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In this latest report from the BBC, we see that our friends across the pond are just as obsessed with appearance as we are in America. Apparently, women in their 70’s and 80’s are getting cosmetic breast surgery and face lifts.
One surgeon is quoted as saying:
“We have a growing population of pensioners – and for those who want to maintain a good appearance, ageing gracefully, the surgical options are there.”
Since when did gracefulness have anything to do with surgery?
I wonder if we’re missing the more important things in life (friendship, love, kindness, charity) by focusing on our exteriors? Beauty is a matter of the heart, I think.
Sophia Lauren once said, “Nothing makes a woman more beautiful than the belief that she is beautiful…” but then again, it looks as if she’s chosen to have extensive cosmetic work done as well.
What do you make of the growing trend in plastic surgery among seniors?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
