May 10, 2012

Ten Bad Assumptions Patients Should Not Make

If you wonder why I praise Dr. Rob Lamberts, take time to read a few of his blogs. Not only are they doctor oriented, but they are also meant for the patient to read and learn. He stopped blogging for some time last year, but is back and putting more common sense out for patients to use. This blog is excellent reading and should be paid attention to since he openly admits doctors are fallible and make mistakes. Even I picked up some good pointers. Others I have been aware of and have picked up the slack when my doctor forgets. If only our or I should say my doctors were this open to admitting they were fallible.

I like several of his opening statements. Patient – pay attention! “Don't assume anything. Assumptions can kill.” Does he mean this? Yes, and then he lists ten potentially harmful assumptions. I can only add – if you don't read this, then you have a lot to lose and it could be fatal.

I am taking his list and adding my thoughts as a patient:

Standard care is the right care
That is right; do not assume that you are receiving the right care. The medical community has attempted to make this clear in several ways. You should be aware of this regardless of where you are a patient. I suggest you read this by Trisha Torrey about the Choosing Wisely Campaign. Dr. Lamberts uses several from different specialties, but they are good pointers and you do need to question your doctor if any of these are suggested.

My doctors communicate
I have found this to be a problem. Doctors do not communicate as much or as often as they should. Even though doctors may not like this, I have been forced on numerous occasions to tell a doctor something that another doctor should have already told him. One instance was a recent surgery where I made clear reference to the fact that I was a person with diabetes on insulin and unless they could guarantee that my IVs were dextrose free, and then they had better be matching with an insulin input. Well, you guessed it, no communication. Surgeon felt it was not necessary until I filed a formal complaint. Then he had reasons for ignoring me saying I had not informed him of my endocrinologist. I had also stated that in my complaint that he had ignored the policy for treating people with diabetes established by the endocrinology department.

Therefore, I learned two lessons here. Make sure everything is in writing and that the signature indicates that they (the doctor and maybe some of the staff) have read and understood what was stated. I did have to correct my blood glucose reading of 300 that was recorded by me, as soon I was able to get my hands on my testing supplies. So much was ignored by the surgeon and his staff.

My doctor has accurate records
Never fall into this pitfall. Most medical records are very incomplete! Items that should be part of your records seldom are. Some of it may be, but even then may not be as complete or comprehensive as the information should be. Few patients have doctors that will let them review records for completeness and not without many delaying tactics and attempts to remove information they do not want you to see. Doctors are notorious if not nefarious for their personal notes about the patient. Often this contains personal observations about you they would be embarrassed to have you see.

Few, if any, patients keep notes about their visits to the doctor with updated lists of medications, surgeries, problems, and family/home situations and bring it with you on visits to your doctor. However, this is a recommendation that you should start. Often doctors will have much of this information in your first visit and will often copy this for you, so don't be afraid to ask.

If you have a doctor that openly allows you to look at you own records and makes corrections pointed out by you, you have a rare doctor and need to cherish this doctor and cooperate with the doctor. For more information when there is reluctance to let you review your records, please read this.

No news is good news
This is one assumption that could kill you. Doctors do forget, and office staff personnel are not the best as relaying information back to the doctor. Too many office staff just assume that the doctor already knows the information and even though it came in a fax they just received or they opened it from the mail, they file it in the patient’s record file. Now what good does this do the doctor and you as the patient waiting to know the results of the tests. This is why you must pick up the telephone or the cell phone and call the doctor's office. Explain the purpose of the call and the test you are waiting to receive the results. Do not accept the answer that the results are in the mail. This is a ploy some office staff people have to get rid of calls quickly so they can get back to the important gossip they were discussing. Over the years, I have seen and heard this and more. Always make sure that you get a copy of all lab results, as this is one way to help track your own health.

I will be notified when things are due
I would not try to take this to the bank. Doctors are busy and the doctor’s office staff thinks they are busy, but they do not have a daily file of when to call patients or when something is due. Even most offices with computers do not have this programmed to call a patient the day before to remind them of their appointment the next day. A few do, but do not use it. Others have found it and do make use of it. Even in this day of electronic health records, or electronic medical records, the saying of garbage in equals garbage out holds true. If it is not entered in the records, that test you were to have had will not happen, unless you make yourself a note and remind them that it is due. Do not be afraid to ask. It is rare to have a doctor’s office that records things timely and keeps the office operating efficiently. Even then, mistakes are made.

Hospitals care
Yes, hospital do care – about one thing and one thing only – the bottom line. If you believe they care about anything else, then make sure you are not in the obituary column of today’s paper. By all means, read Dr. Lamberts discussion on this.

He make it very plain the intent of hospitals and their profit motives. So if your doctors work for the hospital like mine do, be very aware of what Dr. Lamberts has to say, it could save your life. The hospitals like to use unneeded tests and tests with high profit margins on unknowing patients.

And. if you do not believe Dr. Lamberts or even me, read this article about our uncaring and unscrupulous hospitals and their desire for profits.

More is better
Dr. Lamberts is right on about this. This is an assumption that can be costly and cause more problems than it cures. We have all been bombarded with the commercials for different medications they want you to talk to your doctor about and get a prescription to take the medicine. If you are a hypochondriac, then I can understand your instance that you have this condition and want the medication. But chances are your doctor will not agree with your assessment and you will be better off and not lighter in the pocket as a result.

New is better
Oops, I made a mistake and mentioned this for the last item. Well they can apply in both cases. New is not always better. Please read what Dr. Lamberts has to say on both items.

The doctor will think I am stupid
Dr. Lamberts has the right attitude on this one and I hesitate to say more. But what the heck, with the exception of a few doctors, most already have this opinion of patients, so why disappoint them. Just remember when you have this thought, you might actually teach them something new or give them a challenge they have no answer for. I enjoy making a doctor squirm when he wants to prescribe a new medication. I ask what the side effects are and whether this will be a lifetime medication or a trial to possibly replace another medication. If it is to replace another medication, then I let them know if the veterans administration does not carry it in their formulary, forget it. If I do not recognize the drug, I make sure I get the name correctly spelled out and say I will look it up and talk to them the next visit. Needless to say, my doctors are now onto me and know better than to bait me on this.

They also know if I am complaining about something, they had better listen, as I do not mince words when I think a doctor is ignoring me. When a doctor did not believe me, and would not give me a referral, I got the referral from another doctor and was right in requesting it. The ear, nose, and throat doctor made a point of letting him know how bad my inner ear infection was and how I had gotten there.

Doctors don’t want to be questioned
I will admit it has been a few years since I have had a doctor tell me to be quiet and listen. Most doctors do want questions, but the right questions to let them know you want to be in compliance with their instructions. Even this is wrong in my opinion, but it is a game that must be played with some doctors just to get to the questions you really need to ask. Just be careful how you ask as not all doctors have the qualities of Dr. Lamberts. A few doctors are so full of their own importance that they will not answer your questions. These are doctors to avoid, as you never know whether they have heard you or not. Their egos are blocking their view of you and you will be lucky to get out of their office unscathed.

Do – repeat – do take time to read Dr. Rob Lamberts and his blog. We need more doctors as straight forward as he is. He sets the bar pretty high for other doctors to get over.

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