Wednesday, September 18, 2013

Buyer Beware

Gertrude wasn't able tell me herself. She was ninety years old and moderately demented. It was her daughter who called. She pleasantly greeted me as I picked up the phone.

We had a good working relationship, Gertrude's daughter and I. We navigated a heart attack and stroke, multiple hospitalizations, and many discussions concerning end of life care. Gertrude was well taken care of. She was lucky enough to have a group of helpers who were under the doting, watchful eyes of her daughter.

In fact, the last pneumonia and urinary tract infection were both treated successfully at home without need for hospitalization. I guess I took it for granted that Gertrude would be a part of my new practice. I had no doubt she could afford it. So I assumed that this would be a phone call about some pressing issue or another.

But I was wrong.

Gertrude's daughter called to thank me for my service, and inform me that her mother was moving to another office. Her voice was smooth and confident with a tinge of pride as she gushed about the first visit that occurred earlier that morning. Although saddened by the realization that I would never see Gertrude's warm if not vacant smile, I tried my best to be gracious. I offered to have my staff forward the medical records, and wished them well.

A few days later, I received a letter from Gertrude's new doctor. He thanked me for the referral, and enclosed a copy of his note. My hands started to shake as I read the assessment and plan.

Gertrude, my ninety year old demented woman, was referred for a screening mammogram and a colonoscopy. To add injury to insult, he ordered full lab work including a cholesterol panel.

No matter how depressed I am at this unbelievably inappropriate care, I can't complain. It was I who changed things up on Gertrude. I have no right to be indignant. But I would like to offer a word of warning for all those out there looking for new doctors.

Buyer Beware!

You can no longer be a passive force in your own medical care. Before you race into the bosom of a new provider, do the research. After each visit, question each new prescription and lab order.

And above all else,

Verify. Verify. Verify.

8 comments:

Anonymous said...

I have been with the same doctor for almost 20 years and about 18 months ago he transferred his offices to the IPA's umbrella. He has been in practice since the late 70's so I suppose he is planning on retiring one of these days. I have used the new doctors in his group as a source of last resort. I have tried every single one of the other 4 and they always want to re-invent the wheel without looking at my history. Somehow book education trumps longevity in their eyes. They seem to be offended when I ask too many questions or tell them to justify their reasoning or the worst - tell them NO. My doctor and I have a great relationship whereby he understands it's my body and my decision and he is the one that diagnoses me and gives me options and information so I can make informed decisions on how to proceed with my care. I will be sad when he retires as there are not enough doctors like him anymore. I know when that happens I will be searching for a new physician as there is no way I will stay with the rest of them.

Anonymous said...

Dr. Grumet,

I can understand your point. I'm at the other end - I get diagnosed without testing. The docs I have (with 2 exceptions) have no problem with booting you out if you question. If you verify and catch them (and oh yes, I have) that's usually the end of it because you "don't trust them". We all make mistakes, can't we just fix them without needing lawyers in the exam rooms?

Another big issue: I like written instructions. Not to sue, but to have as a list to follow what the doc wants, if I don't understand something, ask questions later, and if I can't follow it, to tell them why. You'd be just as shocked to find out most docs won't do it: afraid of getting sued more so than helping their patient know for sure, when they get to the store another day, get the correct dosage of an OTC med they want them to take.

Btw, I asked both of the "good" docs' offices if they had bosses & who they were, because I wanted to tell them just how much I appreciated the care. I even listed examples and why they were important to my care, and some of the bad stuff that happened. I wanted them to understand just how much some of these things made a difference.

So some of us do appreciate good care.

Anonymous said...

Dr. Grumet,

I can understand your point. I'm at the other end - I get diagnosed without testing. The docs I have (with 2 exceptions) have no problem with booting you out if you question. If you verify and catch them (and oh yes, I have) that's usually the end of it because you "don't trust them". We all make mistakes, can't we just fix them without needing lawyers in the exam rooms?

Another big issue: I like written instructions. Not to sue, but to have as a list to follow what the doc wants, if I don't understand something, ask questions later, and if I can't follow it, to tell them why. You'd be just as shocked to find out most docs won't do it: afraid of getting sued more so than helping their patient know for sure, when they get to the store another day, get the correct dosage of an OTC med they want them to take.

Btw, I asked both of the "good" docs' offices if they had bosses & who they were, because I wanted to tell them just how much I appreciated the care. I even listed examples and why they were important to my care, and some of the bad stuff that happened. I wanted them to understand just how much some of these things made a difference.

So some of us do appreciate good care.

Joy Ali said...

what was wrong with the new doctor wanting updated tests and labs?

Anonymous said...


The truly sad part is that Gertrude's daughter now likely thinks you have been under-treating her mother all these years by NOT doing these things...

Perhaps new MD works for a corporate entity that ties his quality measures/bonuses to ensuring the "boxes are checked" for screenings regardless of any thought toward utility or appropriateness.

Besides, bad things NEVER happen during colo's and surely everyone wants a breast biopsy, right?

Anonymous said...

To Joy Ali --- a mammogram and colonoscopy will only hurt this woman. Unnecessary. Unless she has at least 10 years of robust life expectancy the detection of a cancer now is of no benefit to her. treatment not needed and won't help prolong life. at age 90 she is going to die of something else and we have just tortured her on the way. worse, the treatments may well hasten her death. extensive labs at her age, same thing. we can test and bill test and bill test and bill, but those things do not help a 90 year old women. I have been in practice for 17 years and the longer I do this, the more I realize how lacking common sense and humanity is in modern medicine.

Anonymous said...

Sadly when you dare to question your doctor you will be labeled forever more as "non-compliant" and dropped from the practice in some cases.

My last visit with a doctor at the leading direct care model in Seattle (IE I PAY EXTRA) started with a print out of recommended tests including a bone density scan (I am under 45) a full blood panel and when questioned she asked if this was the right practice for me and referred me out.

Health care is a business now and the power rests with the providers and it is unfair to ask patients to be not only more informed than our doctors but to challenge them when we are feeling ill or caring for a vulnerable family member.

Jennifer

Anonymous said...

My comment could become a blog itself..
You took care of patient I took care.And you changed his last years of life..I will be gratefull for that for ever..
Because this person changed My life ..
Thank you,Dr.Jordan..