Monday, May 3, 2010

Things that make me grumpy

Ms. Crappystaff: "Dr. Imed's office."

Dr. Grumpy: "Hi, it's Dr. Grumpy. You guys referred Mrs. Brain to me for an abnormal MRI, and I don't have the report. She's here now. Can you please fax that over, ASAP?"

Ms. Crappystaff: "Hang on... Sorry, the doctor just went into a room with a patient, and doesn't like to be disturbed. I can have him call you back later."

Dr. Grumpy: "I don't need to talk to him. I just want you to fax over the MRI report."

Ms. Crappystaff: "I'm not comfortable doing that. I don't know what the report means."

Dr. Grumpy: "I'm not asking you to know what it means. All you have to do is fax it to me."

Ms. Crappystaff: "Don't patronize me. I don't even know who you are."

Dr. Grumpy: "I'm Dr. Grumpy. You faxed over an insurance authorization on this patient an hour ago. I just need the MRI report, so I know what to tell her."

Ms. Crappystaff: "I told you, I'll have Dr. Imed call you to discuss this."

Dr. Grumpy: "The patient is here now. I just need the MRI report. Please fax it over. It's why you guys sent her to me."

Ms. Crappystaff: "You obviously don't understand the importance of patient privacy."

And she hung up.

51 comments:

Anonymous said...

omg, what do you even do with that?

The Good Cook said...

Wow. Just Wow.

Celeste said...

She obviously doesn't know the importance of being competent at what you are paid to do.

I so hope you'll get a chance to speak with her employer, and I hope it will result in re-education, if not an apology.

Nectarine said...

when "CYA" goes too far.

Amanda said...

GAH!!!

Anonymous said...

Yikes. Don't doctors usually take doctor's phone calls when it's important? I know that the nurse has knocked on the door and entered the room and said, "Excuse me, Dr. Ineedabrake is on the phone can you take the call?" And he will turn to me (this is my MD I am talking about) and say, "Excuse me I will be right back!" I am totally fine with that becasue if it were me they needed to talk about, I would want the doctor to leave to talk to another doctor. I say someone is going to get a good ass chewing when you finally do talk to Dr. Imed! OMG! How close is his office from your office? I say, get in your car and drive over there. That would sure get someone's attention. I know it is NOT possible, but damn a good picture to post when you came in because she wouldn't get the doctor.

John Woolman said...

Do you have the expression "Jobsworth" as in "It's more than my job's worth" in the US? An excuse widely used by those who wish to adhere to the letter of ill understood laws or regulations rather than to make the effort of using what passes for their intelligence.

WarmSocks said...

And this is why I get copies of all my test results. More than once I've been asked to sign a release so that two different offices could play fax-tag. Instead I just hand over a copy of the desired report.

Grumpy, M.D. said...

Anon 10:17- I wasn't even trying to talk to the doctor. All I wanted was an MRI report.

Old MD Girl said...

Sounds like the staff at my former Chicago PMD. :-P

Anonymous said...

Grumpy, I know you didn't want to talk to him but she obviously thought either she did or your did. That's why I asked. Would your gals pull you out of a patient room for another doctor if necessary?

The Mother said...

I'm thinking that someone else doesn't understand patient privacy.

It astounds me how many times we have had to explain to DOCTORS that medical records legally belong to the PATIENT. You'd think they'd know that by now.

Grumpy, M.D. said...

Yes, they absolutely would.

Kalieris said...

@Warmsocks, you'd probably get a lecture from Dr. Imed's staff about how asking for your own reports violates patient privacy.

Maha said...

I'm in awe of you for not exploding with rage right then and there...

Doris said...

There are some people who believe their job is to be a flapper (a la Gulliver's Travels) even when no flapping is necessary.

I hope the patient hadn't moved Heaven and Earth to rearrange her schedule to see you...quite apart from being anxious about test results...

Just ARRRRRGGGGHHHHHHH!

Phathead said...

Remember Grumpy, always defer your many years as a physician to the knowledge of the lowly secretary...

Anonymous said...

I thought you'd find this interesting blog fodder...

http://www.thesun.co.uk/sol/homepage/news/2954500/Chef-dies-after-feeling-eel.html?OTC-RSS&ATTR=News

I'm sure it opens up a whole new aspect of what you MD's deal with on a daily basis.

Love your blog! Cheers :)

WarmSocks said...

@Kalieris - bypass Dr. Imed. The MRI place will give me a disk to hand-carry to consulting doctors - report and all pix instantly available. And my PCP's staff doesn't give me any grief when I ask for a copy of a report (I've done it so often that now they ask if I have my copy yet) - they're really nice about it.

Andrea said...

It's sad how many people won't do anything because they are afraid of HIPAA.

My husband needed preauthorization before seeing a new doctor per our insurance company (the one with a cross and a shield; the color shall remain nameless). I, being the policyholder, call on his behalf and they refuse to put the authorization in place without speaking to him "because of HIPAA".

I try calling back later and I speak with another rep, and I will be giving her the doctor's name, they still claim that it would be a violation of their HIPAA policy. Bullshit.

Yet this insurance company has no problem sending ME, not my husband EOB statements showing exactly what services were rendered.

Livvy said...

Did you let your patient know so that he/she could call to directly scream at Ms. Crappystaff? (also could directly request release!)

Anonymous said...

she needs to be in the ellisville state school. it's in ellisville ms. its one of the biggest homes i know of for the mentally chanllenged. sounds like she needs to be admitted there.

Anonymous said...

Wow. Good to know that HIPAA is poorly understood everywhere. I also get copies of tests so I can hand them to my doctor directly. One particular primary doctor's office was staffed with a bunch of idiot's and refused to give me my lab tests -- she said it was due to privacy issues. (I have a new dr. now)

Anonymous said...

Yo Dr. Imed, fire that unhelpful bitch. Gotta be a lot of people out of work nowadays willing to step up to the plate and do a better job than that.

terri c said...

Poor patient and poor Dr. Grumpy. What did you tell the patient? "I am told you have an abnormal MRI and that could mean all sorts of terrible things are wrong with you, or that nothing is wrong with you. Unfortunately I can't tell you any more because your physician's office will not share the report..."

The Evil Receptionist said...

To play devil's advocate for a sec:
It's quite possible that Crappystaff was unaccustomed to having an actual physican call and request something, that she may have thought Dr. G was not who he said he was, and therefore didn't want to risk sending it. However, I could be totally wrong and she may just be a random idiot who gives good receptionists a bad name.

When I call to verify patient appointments, whomever I speak with HAS to be on the HIPAA release. If they aren't I can't speak to them. They could be a sibling, child or spouse of 50 years, doesn't matter. My employer doesn't budge on that one.

Sandra said...

Kalieris,

When I changed OB/GYNs (after my move), the previous one would send documents to my new doctor but would not give them to me because of privacy.

Sandra

Dana said...

Here in Australia, I asked to see my file while I was still in the hospital. I kinda understand most of the things in there, and I like reading the doctor's comments.

Anyway, they told me in order for me to read MY file, I would have to apply for it under Free Of Information. I would need to file in a form and see if they authorised it. Then I would have access to my own file. Madness!!!

the observer said...

That's just...ARGH!

Patient's records belong to the patient.

When a patient has come to the ER and this is not their regular hospital (due to ambulance diversion, whatever), and we don't admit them, and they ask, I never hesitate to send them home with their stuff.

Yeah, you do have to be sure about phone communication--if not sure, the fax seems to me would be a good back up, no?

Yup, Dr. Imed could use new help.

Anonymous said...

hipaa allows the exchange of phi between caregivers who are directly involved in a patients care when that information is relevant to the specific care. still, a signed roi, which can be faxed, is comforting to all involved.//// unless i have warned them about an expected call, my staff will not interrupt a patient visit for any outside call. occasionally they deem it necessary to interrupt, and i have never complained. i sometimes pause a visit to go answer a page. some pages get lost and forgotten.

Kim said...

I was once told, while changing doctors, that they would only send my medical info to the doctor, not me, and in order for them to send any info to the new doctor it would cost me $25.00. I was beyond pissed. I decided that the new doctor and I would just have to start over...pretend I had never seen a doctor before, and I would tell them whatever I could think of about my medical history.

Does anyone read Hippa? Seriously, I don't think anyone reads those at all.

A Doc 2 Be said...

Kim,

Trust me:

Lawyers read HIPPA
Management consultants read HIPPA
Accountants read HIPPA
HR reads HIPPA

Only those with no control actually read the thing, or those looking to use it as another excuse to make more money off healthcare.

I was one of them :) (key word: was)

hekatesgal said...

Hell, I've lied and said I'm my husband or whoever. And I've listed my own home as a Drs office in order to get records. Yes, the records are mine. But no, they didn't want to send them to a non-md. (Think she was afraid of malpractice possibly.)

Anonymous said...

Evil Receptionist.....how do you know the person on the phone when verifying appointments is who they say there are? They could say, "Yes, I am Mrs. Smith," when in fact they are the daughter or whomever. This question is no different than you playing devils advocate that how did she know it was really Dr. Grumpy?

Cthulhu Sashimi said...

I think you were supposed to offer her a bribe.

Anonymous said...

Kim, there may be more to transferring your records than you think. Your old doctor cannot just hand you the original copy of your chart. Legally s/he has to store it for a certain number of years. (What if you need access to it a few years down the road and you lost your copy of the records?) So when you ask that your records be given to your new doctor, your old doctor has so sift through your chart (which may be inches thick by now) to pick out the pieces that would be relevant for another doctor. There are preliminary results, duplicated information, chicken scratches about minor issues that are not useful to someone else. Then someone in the doctor's office gets to photocopy each paper... all of this takes time and paper.

Are you still beyond pissed about a $25 fee for this extra work?

- A Canadian Resident

Phathead said...

Anon @ 6:56pm - The caller ID can tell you a lot. Virtually all places have caller ID in the office.

You have no idea how many 'refills' were called in from 'doctor's offices' but were really from someone's personal cell phone.

Angie said...

Legally, a doctor's office can fax a report to another doctor's office for continuation of care. I work in a hospital in medical records so this is something I deal with every single day. Yes I can send your report to your doctor. No I can't send it to your fax machine. No I can't tell you anything, including whether or not "you" have been in our facility. I don't know you from Joe Blow and I am sure not going to send you something personal without proof. If you think about it, most don't have a problem with this. Would you want your MIL or your husband's exwife getting a copy of your personal files? Most people wouldn't.

As to the people who get mad about having to pay for records... sometimes I print out 500+ pages of records for one chart. Paper isn't free and neither is the time of the person getting the records for you. Records are a service just like anything else. Although, if you are having to pay 25.00 for 6 pages, yeah I would irritated too.

Sgent said...

Just wanted to point out that patient records in the US are usually the property of the provider (physician in this case) -- not the patient.

Most state laws and federal law is pretty clear on this point. Patients have a right to review their records usually (there are certain exceptions esp for psych issues) for free, although copies may cost.

RSDS said...

Patient records DO NOT, I repeat, DO NOT belong to the patient! They only belong to the medical establishment. Patients are NOT supposed to know what is in their record. That is priviledged information only for medical providers to have access to.

At the VA hospital that I used to go to (not the one I go to now, where everything is on computer)if I had multiple appointments, in different areas, and needed to hand carry my medical records from one to another appointment, my records were ALWAYS put into a SEALED bag, so that I would NOT have any access to them. Because patients are NEVER supposed to see what is actually in their records.

RSDS

Anonymous said...

The Evil Receptionist,
She would just be faxing it to the same number she sent the insurance authorization to earlier, no HIPPA violation if she does that. Ms Crappystaff is just an idiot.

Moose said...

Patient's records belong to the patient? Someone please tell that to my former doctor's offices. One is a clinic with a "records office" that never answers the phone, returns messages OR LETTERS, the other was a practice in a hospital that folded. Neither the hospital nor the overall hospital system knows where all the records went. The past 7 yrs of my medical life, including some serious, serious stuff, is completely missing. GAK!!

In related news, i call Shenanigans on the eel ate the chef's bowel story. I never heard of man eating eels, and the Sun is known for sometimes trying to be the UK version of the Weekly World News [which I miss, oh! so much!]

Emma said...

I love the "patient privacy" dodge. Usually it's from someone who doesn't understand squat, but who has been made a gatekeeper just the same. Pharmacists are medical professionals who have a professional duty to ensure they're not over- or under-dosing someone, yet the diagnosis for a medication is rarely on a prescription blank...and medications can be used "off-label", or for something other than what they were originally approved, and in doses very different than you might imagine. Yet, when I call a provider's office for more information, I get told, "I can't tell you any information, that would be against HIPPO". Yes, hippo. poor, innocent animals.

That's not to say that I don't occasionally have very informational exchanges with providers, wish we all had time for more!

Anonymous said...

So...inquiring minds want to know what happened next. Did you call Dr. Imed directly and tell him that his gatekeeper is a idiot?

Grumpy, M.D. said...

No, I became violently ill and had to go home sick (unrelated to Mrs. Crappystaff).

Mary had the patient sign a release, and we got it from the MRI place. I'm calling the patient today.

The Evil Receptionist said...

Anon @8:56--I always begin by asking for the patient by first name. If they aren't home/can't answer--we move on from there. I usually ask the name if the person I am speaking with and if they're not on HIPAA, I politely end the call.

Truth is, I'll never really know.

Anon @11:22--Excellent point--which makes her a garden variety idiot.

Kim said...

Yep, I am still beyond pissed. The records are all computerized, all they had to do was print them out and mail or fax them, or send via email...that does not cost $25.00. This particular doctor's office hand wrote nothing...no chicken scratch. Not only that, but this particular doctor was an arrogant SOB, and I liked nothing about him. Nothing. I also think he had a mental illness of some sort...he was way up, and he was way down...you never knew what type of mood he'd be in and he was very volatile. He didn't get the money for the transfer of the medical records, and he lost my family and several others as patients. I'm happy with our current situation. Oh, and with our current situation, they have told us that they never charge to transfer medical records, we can can have access to our own records any time because they belong to us. As a matter of fact, I have always been able to look at my medical records, except for with that particular guy, and I have never been charged to transfer records when I needed to do so because of a move. It was only that one particular office. Bah.

Nurse K said...

Actual conversation recently:
Me: Hi, we accidentally sent some original paperwork from our hospital to your hospital with the patient when we transferred her there for psych. I'm wondering if you could fax me a copy back.

Med records: You want to transfer a patient here?

Me: Nope, I'm looking for paperwork for a patient we transferred there about a week ago, and I was told she was discharged.

Med records: Okay, hold on.

[Pause] "This is the psychiatric social worker, I understand you need to transfer a patient here?"

Me: Nope, transfer me back to medical records.

Me: Hi, I'm still looking to speak to someone who can look up a chart and fax me a copy of our documentation.

Med records: Okay, hold on...

Med records supervisor: I understand you keep calling trying to send us a patient, and you really need to go through the psych social worker, not medical records.

Me: I just need someone to look up a chart!!!

Med records: Oh, a chart? You just need info from a chart?

thegooddrlaura said...

Do I really need to be the 49th comment? Probably not, but...
I want to know if my staff is being bitchy to a physician (or to a patient or to anybody). I left a doctor's practice (as a patient)because her M.A. was a bitch. Dr. Imed should know that his receptionist hung up on a consultant.

Shalom said...

I think everyone in the business has run up against HIPAA at some time. I remember one day I got a call from a medical-type person (probably a nurse, IIRC) at a prison; they had someone recently arrested who needed to have a list of the meds he was on. This was in the early days and nobody knew what you could or couldn't do. I told her to hold on and called the corporate privacy officer. She informed me that under no circumstances was I to fax a copy of the patient's records without a signed release from the patient (who was in a cell at the moment and in no position to sign one), but I was allowed to discuss them over the phone with a medical person. I so informed the nurse, and she said "So you can read me the list, but you can't fax it? Isn't that kind of stupid?" I told her "You know, that's exactly what I said when they told me, but this is how they want me to handle it or I'll get fired." So I had to read out the list of meds over the phone for her to write down. I'm pretty sure in hindsight that the company privacy officer got it wrong, but when did that ever make a difference to a corporate drone.

Oh, and if you ever do get a word in edgewise with Dr Imed regarding his employee, please do let us know what, if anything, happened.

Dr. Cindy said...

I recently called a specialist to whom I referred a patient, asking for copies of his notes on our mutual patient. I even had a signed records release. His receptionist refused to send them - "only the physician can copy and send records." WTF, really? The highest-paid person in your office is the one who does the photocopying and filing?

I left a sternly worded message for the MD, including the phrase "unable to send you any future referrals," and he called me back promptly. He is so afraid of HIPAA that he will not allow any staff to access his medical records...now that is a serious misinterpretation of the intent of the law, when a physician is doing all the photocopying for the office!

 
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