On the surface, this seems like a
no-brainer, but the outcome is in the details. It is often easy to
see why some practices fail and many patients are often the cause of
a medical practice on the margin not staying in existence. Word of
mouth is very strong among patients that are not happy with the care
they receive and can be the cause of a practice not succeeding.
Many years ago, I was a patient in a
practice that was not doing well and I had to evaluate if I was going
to stay or try to find another doctor. More than once, I was told
that a test result was in the mail and never would receive it. Then
one day I happened to be in the waiting room and heard the office
manager tell a patient that something was in the mail. As soon as
she hung up the phone, she and the receptionist were joking about it
and went back to exchanging the latest gossip about a patient. I
don't know whether they knew I could hear or even cared that other
patients in the waiting room could hear, among them the patient they
were talking about.
I could see the patient getting very
red faced and it was not long before she got up and walked out the
door. Then another patient got up and left and only two of us were
left to listen to the two of them continuing to run different
patients down. As the two of us got up to leave, the nurse was at
the door calling my name. The other fellow continued to walk out the
door. The nurse wisely waited until she had me in the room and asked
why patients were walking out. I told her none too politely that it
was the office manager and the receptionist causing patients to
leave. She stated that the office manager was the doctor's niece and
nothing could be done about this. Then she stated that this was her
last day at the practice, as she could not get along with the office
manager.
Shortly, the doctor walked in and I
admit I was not it the best of moods. When the doctor asked what was
wrong with me today, I opened up with both barrels and probably said
more that I should have, but I wanted him to know that I was leaving
and why I was not coming back. This was long before HIPAA (Health
Insurance Portability and Accountability Act of 1996), so there were
no regulations in place to protect patient rights or privacy, only
what the doctor determined was right and wrong. As I was walking out
the door, the doctor said he would not fire his niece. I quipped
that because of her he had lost four patients in less than an hour
and he should reconsider.
Two months later the office closed and
I heard the doctor was in a large city in another state. He did need
to return for the trial against him, his niece, and the receptionist
for defamation of character, which they lost. Shortly after all were
gone out of town and I have heard nothing more about them. Before
becoming a patient of my current doctor, I left two other practices
as a patient because of overly chatty office personnel. My current
primary care doctor is a hospitalist and seems to have new staff
twice a year. On one visit that was my first question. He answered
that seems to be the only way they could prevent overly chatty
receptionists and others for violating HIPAA. The office manager is
very strict about HIPAA and terminates any employee caught violating
patient privacy rules with no second chances.
I did get an opportunity to visit with
her and I can appreciate why the doctors like her so well. She
requires every new employee to read the pertinent rules and sign that
they understand them and what will happen if they are caught
violating them. Her only comment that I agree and support is how
often people think they can get away with looking at a patients
record and then chat about it with other people. I could only say
that three employees were people that I have seen for more than one
year. That does not mean that there couldn't have been more tending
to patients or on a day off. I do know that a few are rotated to
other departments on a regular basis. I know of one that I see in
different departments and she did say she likes the rotation for the
variety of duties she can do.
The above is just one reason that
physician practices fail. There are others – financial
mismanagement, not making the patients feel welcome, doctor
indifference, and communication failures. Yes, some practices hang
around because the patients are totally passive and as long as they
get the pill they need to resolve a health problem, the patients are
none the wiser and care less about how they or the office is handling
their records and problems within the office.
As patients learn more about HIPAA and
become more empowered, this is slowly changing for the best.
Patients are demanding better health care, respect as patients,
patient privacy, and access to their health records. In many cases,
patients are active in opposition of some budget cuts by Medicare
that is damaging good doctors financially. One doctor that is in a
clinic knows me and that I can advocate, asked if I would support him
and others by writing our federal elected officials. He looked
rather hurt when I said no. He did have the courage to ask why. I
pointed out several personnel deficiencies I could see just standing
in the hallway. We had an unobstructed view to the receptionist and
billing department. Three employees could see us, but they continued
chatting and one pulled out a patient file and they started talking
about that patient.
The doctor was getting the idea and we
moved to the other side of the hallway and closer to the talk. No,
they were not talking about a coding problem in billing and it was
rather clear they were talking about a patient and what the medical
problems were. The doctor admitted he had heard enough and asked me
to go to the waiting room and return with the two patients closest to
where the employees were talking. I was surprised that no questions
were raised when the three of us headed down the hall to the doctor's
office. When we got to his office, he directed them into his office
and got them seated. He then carefully asked them if they had
overheard what the employees were talking about. One of the patients
said she knew who they were talking about and was clearly upset about
this. The other patient said she knew that they were talking about a
patient, but did not know the person. At that point the nurse who
had been with the doctor's next patient knocked and entered the
office. When she saw the three of us, she apologized and started to
leave, but the doctor asked her to stay.
He asked if these were his last two
patients for the day and the nurse checked the schedule and said
there was one more already waiting to see him. He asked if they
could wait an hour while he corrected a problem and the two said they
could come back another day, and they understood and appreciated his
need to correct the problem. The doctor asked the nurse to take
their names and phone numbers to call them later or the next day and
reschedule them. He thanked the three of us for our information,
said it would be taken care of immediately, and asked the nurse to
escort the two patients back to the waiting room to leave. I started
to leave and he asked me to stay and got the nurse to check if the
patient was the one that was going to be leaving for vacation and he
would see her if that was the case. She was not and agreed that she
could come back another day.
The doctor accompanied the last patient
out and asked the three employees to come to his office while the
nurse and I answered the phone and took care of anyone coming in.
The nurse was still in the dark and once the door to his office was
closed, she asked if there was anything I could say. I said “HIPAA
violation.” She said “good” and that was the end of the
conversation. The nurse went to a filing cabinet, pulled out a stack
of papers, sat down, and started looking through them. She stopped
and asked what my position was and I stated just a friend of the
doctors. I asked if she knew where the HIPAA file was. She said in
the doctor's office, and I asked if any of the computers were hooked
to the Internet and she stated only in the doctors office. Then
someone came in and the nurse sent her directly to the doctor’s
office and then said to me, “the payroll clerk.”
The doctor called the nurse and asked
her to find three boxes for personal belongings and to stand by to
enter his office when he brought each employee out. The doctor
brought one employee at a time to remove her personal belongings and
then escorted them to the door. When he was finished, he asked the
nurse to get him the applications file. She handed him the file and
she said the three positions for each were clipped together in the
order she thought would help him. She said your friend has something
to discuss about HIPAA. The doctor instead said he wanted to
apologize to his nurse for not taking her serious and having a friend
make him realize that things were not right.
Then he asked what was on my mind. I
asked him if he had the HIPAA rules and he said he did. I told him
it would be a good idea to have a copy together with a paper stating
that the employee had read and understood them and a place for them
to sign to that effect. Then a second page stating that if they
chose to violate the HIPAA rules that they could be dismissed
immediately and a place for their signature stating that they
understood this. This would become part of their employee file. In
addition another copy would be placed where they would see it each
day.
He thanked me for the advice and asked
if in the next three days I would come in and get this accomplished.
I agreed and he asked if I would also be the receptionist for the
next two days and that I would be compensated. Then he asked the
nurse to clear and reschedule the next day's patients and if I could
stay while he looked over the applications and assist with some
calls. We changed desks and he started looking at the applications.
We were fortunate to find seven applicants still looking for work and
scheduled four for interviews the next morning and three in the
afternoon. We reviewed what had been done and only one patient had
not been actually contacted, but a message had been left. Other
partners in the clinic were stopping by and they were sent to the
doctor's office. Sheryl, the nurse, and I finished up and she asked
if I could be there by 7:30 the next morning and when I said yes, she
told the doctor we were leaving. He asked if I needed a key and
Sheryl said she would be in by then. The doctor stated he would have
a laptop hooked up in case I needed the Internet and have it also
connected to a printer
The office returned to normal the
following week and the doctor and I do not talk about it. Sheryl
says things are better than before and they have lost a position when
one employee decided she did not like the work, but that the other
two are doing what three were before. She said that one of the
billing employees from another office does help occasionally.
