Cast & Curious

Tag: patient complaints

  • Close call on rehabilitation

    In the past, I work closely with rehabilitation physician in the course of treating my patients.  Since I went into private practice  in the province though the lack of a Rehab physician in my area pushed me to learn and give rehabilitation regimens to my post op patients. What i discovered first was not really about the nitty gritty of giving exact instructions on physical rehab regimens. The necessity to communicate clearly and cultural sensitivity plays an important role and could save you from embarrassment or worst, the barking look of your own patient.

    Mrs. Cruz (not her real name) is a 56 year old soon to be retiring school teacher I operated on after she sustained an bi malleolar ankle fracture from a vehicular accident. She was a stern looking bespectacled woman, barely smiling but very sharp with her unending probing questions. She claimed to know me when I was still an elementary grade pupil (although, I couldn’t remember exactly if she was one of my teacher), but I suspect she isn’t the type of teacher you and your nasty classmates could play jokes on. Anyhow, I operated on her uneventfully and she is on her first week of follow up post op. Time for rehab I said.

    She was accompanied by her equally stern looking husband, a former military man from the looks of his eyes when she came in my clinic.One of her son was waiting outside the clinic and was I guess an added “assist” should the need arises. I just came from two succeeding ORs, barely had any sleep and was pretty tired from whole day of running around the hospital seeing patients. I am in my usual cool emphatic composure, but it was 4PM and my energy is almost spent since 7 am that day.

    “Good morning Mrs. Cruz,.. Sir!” I said. Greetings which was met by a querying look from both persons. “Hows your operative wound madam?” “Have you been dressing this daily?” I continued. “Yes” she said. I went through the routine of checking her post op wounds, examining it and then removing the sutures after seeing the wounds are all healed already. I then checked her ankle joint’s range of motion. It was a bit stiff even if I did one good operative job and has checked the range of motion intra op to be “full”.

    Time for a “rehab” I said nonchalantly to Mrs. Cruz.

    I was skimming her chart and fumbling on my phonebook at the same time for the cell number of our in house physical therapist. I noticed the couple looked stunned and was looking at me squarely liked I said something really awful.

    “Rehab, doc?”. Mrs Cruz didn’t blink to ask me again. Half stunned, half in disbelief.

    “Yes, Rehab” I replied a bit annoyed and spent.

    Then Mr. Cruz, face red in embarrassment, looking more serious and agitated now,  butted in “Doc, my wife is a teacher, she doen’t have any vice at all, at this age, I really find it hard to believe she is using any drugs!!!” in Tagalog.

    “Ugh!Oh no, no..that’s not what I meant! Her ankle needs physical therapy so she can walk painlessly again on that foot!”

    The rest of this story brought back the adrenaline in me that day. I was totally insensitive, perhaps because I was so spent with toxicity. In a provincial community where I practice, social stigma for drug addicts and sensitivity towards implying one is using any addictive substance may cost you your life. In this part of the country (and in some other parts too), “Rehabilitation” means drug rehabilitation. Many believe its derogatory and I guess, I learned my lessons that day.

    Perhaps clarifying things out, being socially sensitive and a bit more of patience, will save you from your own “close calls” with ‘rehabilitation”.

  • Loyal patient watchers..

    Communication, patient-provider (photo taken from http://www.aafp.org/fpm/1999/0500/p23.html )

    I was doing my usual morning rounds last tuesday when a watcher of one of my patients approached me before I saw their patient in his bed. This watcher mentioned that someone went inside their patient’s room and asked questions that raised the curiosity of the family. The watcher spoke a different dialect and though I understood most of what she’s trying to convey, she fumbled with words and was obviously concerned at the “questioning” incident. I asked about the details of the incident, but none of them can give me a clear idea what was the “questioning” all about.. All I can deduce from the watchers was that someone asked them and “implied” a question of competency  and thus are worried about their decisions in seeking my care.

    Unfortunately, none of the watchers asked (they are probably too shy or too gentle) the name nor remembered the identity of the person. They describe the interviewer as wearing a white dress and was asking other questions like “Why go to this hospital?” or “Who told you or referred you to this institution?”.

    I asked the family then if this did affect their perception of my competency. I heard a resounding “Hindi po” or “No, it didn’t”.

    I suddenly remembered who the interviewer could be. None of these watchers realized  that the interviewer was actually  doing a sanctioned survey.  I have yet to encounter this response variance (meaning, the watcher doubted competency as a result of being interviewed) in any surveys I’ve been involved. This however pointed out one thing- a communication gap between the interviewer and the interviewee. The interviewer broke protocols by not introducing herself (blinding?) which rose suspicion and doubts on the part of the interviewee. Imagine what a simple mistake like this evoking a different response!

    I  felt relieved discovering this fact but was bothered by the communication gap. I spent more time explaining the survey and placate these watchers apprehensions. This time spent explaining will go a long way protecting a provider’s image from a simple neglect of introducing oneself before any patient or watcher’s interaction.

    So doubts? Nah. But I’m sure that staff will have something to learn from communications 101!

  • What should a dissatisfied patient do regarding their physician’s “bad” service

    Recently, I’ve been receiving   complaints from patients regarding some attending physician’s “quality” of service. Complaints like, “the doc saw me late already” or “my waiting time is far longer than my physician encounter time”  or “this was not explained to me” or  the difficulty of some patients (or relatives) to talk to their physicians. In most cases, the attending physician’s technical competence is unquestionable, but the patients or relatives sometimes felt they still didn’t receive adequate care or service from their physicians. What must they do?

    a patient unhappy with the physician services rendered to him (Photo credits from http://www.art-of-patient-care.com/doctor-patient.html)

    I always tell these “complainants’ that any doctor-patient relationship is contractual by nature. Meaning both parties has to agree and deliver their end of the deal to consummate the “contract”. The contract is of course the delivery of health services required by the patient’s current health needs.(Read my perspective of this here.) This may sound simplistic but for purposes of discussion, this “understanding” of a contract should suffice. If one party, does not agree or adhere to the contract, then the relationship could be terminated after due process.

    In non- emergent situation,  and if the service is available, patients have the choice on who will be their doctor or what type of service they could avail. That by choosing or agreeing to be under the service of a particular physician, the patient also has the responsibility of paying the services of that physician. That is the contract, no matter how business like it sounds.   In cases where one party felt that other party did not deliver the expected service , he or she may choose to end the contract after duly informing and after paying the services rendered by the physician. (By the way, the physician under certain circumstances and on valid grounds, may opt to terminate a patient-physician relationship too but let’s leave that discussion in my future posts.)  In my practice, I always offer this option to all my patients even prior to our patient-physician relationship.

    Problem comes in when patients just change physician services without adequately informing their previous and frequently, their succeeding physicians. Far worse is the situation  wherein patients  “leave” their previous physicians without paying their bills on the pretext of a “bad” service.  This is not good practice either and probably will only harm patient’s reputation also.  In the first place and except in emergency situations or some government health training facilities,  the choice of  any physician is really the patient’s responsibility. Health is the business not just of the physicians and institutions but of the patients as well. If you don’t know any of your physicians in the community, then you cannot blame someone else for receiving a bad service. Remember, that physician  gave his or her professional service and in the context of a contractual form of relationship, that has to be duly paid even if you’ll change physicians.

    Patient doctor relationship is based on trust (photo from http://harvardmedicine.hms.harvard.edu/doctoring/patient-doctor/index.php)

    So if you want to change your attending physicians for a valid reason, inform your physician of the transfer. Pay your end of the  contract, meaning the services rendered. Cultivate the habit on talking to your doctors. Pour in your concerns on them and seek necessary answers to lingering questions.   But don’t forget to inform the physician if there’s something good also about his or her service that you liked. I always believe no doctor would want any patient to feel bad about their brand of service. Just be honest. If those physicians do not change for whatever reason, that’s their catch. Remember that health community is far more sensitive than we thought on issues like this. These type of service screw ups always catches up someone else ears. If you don’t like them, then do not patronize them. That way, you won’t complain at the end of your contract. That simple.

    Or is it? What do you think?

    “The essential quality of the clinician is an interest
    in humanity, for the secret of the care of the patient is in caring
    for the patient.”    – Francis Peabody Class of 1907, Harvard Medicine