Friday, May 20, 2011

Dear patient I didn't see,

Sorry I refused to work you in yesterday afternoon. I had an open slot, and would much rather see you here, and get paid for it, then have an empty hour.

But when you called Mary and said you'd had a horrible headache all morning, and couldn't move your right arm very well, she quickly became alarmed that this wasn't something that should be handled in my office. In fact, she told you to call 911, and you refused, saying you'd rather just drive over to see me.

That personally alarmed me, because obviously you shouldn't be driving in your condition. When Mary told me that I decided to get on the phone myself.

Your speech was a bit slurred, and I again reiterated that you should call 911. I even offered to call them for you, and asked for your address or phone number, so I could get them to your house. You refused, on the grounds that your co-pay for an ER visit was higher than it was to come to my office.

Then you told me that you didn't want to see me anyway, because obviously I didn't care about someone who needed help. And you hung up.

Believe me, if I didn't care, I wouldn't have tried to get you to ER.

35 comments:

Kilroy! said...

It's amazing the things people will do to save a buck, even at their own expense. If a medical professional told me I should go to an ER over seeing them, I'm inclined to go to an ER for whatever's ailing me!

Jess said...

Considering the ramifications of avoiding emergency help with a possible stroke, I'm thinking your day pretty well went to crap after that call. I'd be worried sick.

Grumpy, M.D. said...

I couldn't do much else. She wouldn't give us a phone number or address that I could pass to 911, and her name was common.

thatsit said...

Blah! It stinks that you cannot help people like this. If they choose to refuse help, there isn't much you can do.

Wormwood's Doxy said...

Kilroy--maybe she didn't HAVE the extra "buck"...

Maybe the real problem is our crummy "healthcare" system that makes people feel they can't afford to get care.

Doxy

medstudentitis said...

Wow. If that isn't an advertisement for socialized healthcare, I don't know what is.

Officer Cynical said...

What's the co-pay for dead?

Anonymous said...

Was she a new patient? If not, could you have pulled her info from her chart along with the emergency contact person (I would say that qualifies as an emergecy)and call 911?

Did you meet her yet? Meaning at the hospital on the Neuro Floor?

****Shaking head in confusion****

Grumpy, M.D. said...

She was a new patient. I had no old records to look for info on her, or I'd have done that.

She's not at my hospital. That's all I know.

SuFu PhD said...

Next time dial *69 to get the number. Call emergence services and give them the number. They can run a remote lookup for the address or a cell phone trace.

Birthdncr said...

It kind of freaks me out that you can't know if her idea of "saving a buck" was a symptom of her apparant stroke or not. I once saw some confusion only related to a water cup during a stroke. The man seemed mentally fine otherwise, but he was mad as hell that the water cup would not speak to him and answer his questions. Neuro is sooo wierd.

PA Honeybee said...

Many health plans waive the ER co-pay if the patient is admitted. Her head was certainly not in the right place, I hope she got help. That would make me ill, had I experienced it firsthand. I wanted to scream on your behalf upon reading this.

Grumpy, M.D. said...

Agree that she likely wasn't thinking clearly, but still, not much I could do.

kate said...

Oye...I hate getting those phone calls.

"Why would I go to the ER? Are you sure that I shouldn't drive an hour into your office to try and see the doctor while my airway is closing and I'm having trouble breathing? *wheeze-gasp-wheeze* If I drive really fast, I'll probably make it before I pass out."

Single Female Doc said...

We can be all smarmy on this side of the pond and say it wouldn't happen here but sometimes the patients want to see me for "reassurance" first rather than attend A&E. If I tell them to go straight to A&E I am somehow portrayed as passing the buck.
Anyway, give it a few years and the English NHS will have gone the same way (though we may get a reprieve in Wales).

purlewe said...

Once when i worked at a GYN a woman OBVIOUSLY in labor called and asked what to do. We told her to goto the hospital. Her response was that she didn't have permission from her husband to leave the house (strict muslim household) and that she was scared adn alone. Again we asked her to call 911. She said she couldn't without her husband's permission. It was a terrible call.. I completely know what you went thru.. and mine wasn't even a likely stroke. I hope she is seeking care today.

AmandaGal said...

We get those guys in the pharmacy too. They come up to the counter with serious symptoms and ask what kind of OTC thing I can recommend. There have been a few times I've called 911 for them myself, but most of the time they refuse, so I'm left with "see your PCP as soon as possible."

My favorite, though he probably wasn't as serious as some of the others, was a guy who lacerated himself with a weedwhacker to the point he was loosing so much blood he was dizzy. As he stood at the counter, asking what I would do about the wound, I could see the bandage he had put on seeping with blood and drops all over the floor. Clearly, something your pharmacist could help you with.

legalalien said...

yikes. You said she wasn't in your hospital. Have you checked the 'pathology outpatients'. She may have got an eternal discharge.

PharmGamerKid said...

same with amandagal, i have had many arguments w/ patients at the pharmacy counter as i urge them to see a doctor and they try to get me to recommend something OTC.

one time, i have a guy who had a spider bite on his leg and the leg is starting to feel numb. i told him to go to the hospital immediately (we live in black widow country), but he still insist on using benadryl and going home to sleep it out...

donna said...

My healthcare plan allows you
to waive the co-pay in this situation and the hospital would allow you to be billed. I get complex/complicated migraines and get these symptoms a few times. I have been told if I don't go (against their advice or ignore the
symptoms) I could say adios to coverage. I don't think it is a faulty heathcare system, just a faulty patient.

Anonymous said...

The fact that she made such a snide closing remark indicates that she had a fair amount of her "wits" about her.

What happens frequently is that the patient comes to the office regardless of what they've been told.

I'm sure she'll file a letter of complaint with her insurer

Packer said...

Tough day Doc. You worry more about those than they worry about themselves and then they want to dump their baggage on your doorstep. There I said what you can't or won't.

Packer said...

Tough day Doc, there is no shortage of people who want to dump their problems onto the most convenient lap and divorce themselves from any sense of responsibility for themselve. Most folks get over that sickness by the end of their teen years.

Manda said...

This is completely unrelated... I stumbled across your blog after someone linked to you somewhere else. LOVE IT! I'm not in the medical field, but I remain highly amused by your stories. Thanks so much for sharing. We dealt with neurologists for years (most of whom could have been named Dr. Pissy) and you are a breath of fresh air.

Anonymous said...

Can't tell you how many times this happens in my cardiology practice! An office setting is NOT THE PLACE for someone with severe symptoms. Patients just don't realize that we don't have the tools/ability to do testing in the office that they clearly need (ex. stat labs, xrays, etc.) and if they come in they will likely be sent to the ER anyway. It's obvious that you cared and kudos to Mary for recognizing that she needed to go to the ER.

Tee said...

Wow, that's a sad phone call! It must be really frusterating to have had to deal with that and now have no idea if the woman is even okay. I can honestly say that I can't understand her train of thought. I mean, I understand the money issue but if a neurologist was concerned enough to send me to a hospital, I'd go! Sometimes you have to take care of the problem and worry about the details later. Hope the lady got some help in time! It certainly sounds like you did everything you could do for her.

Lois said...

What can you do? There's Darwin's Law at work again.

C said...

actually, it ia bad feature of health care that unless you have a genius family member by your side 24 hrs a day, you have to make tough decisions by yourself when you are sick, in pain, impaired...add to that that hospitals frighten a lot of people and they just do not want to go. My current insurance plan has a 24 hr "phone-a-nurse-for-advice" which I think might help people make a good decision, but I have never used the service.

Anonymous said...

Probably addled in the head from the emergent issue. Poor thing. I hope someone helped her.

Not House said...

I hope, for his sake, that his refusal to come in was a result of his TIA/Stroke, and not because he's a stark raving moron.

spectrummom said...

I have gotten off phone calls like this and just screamed. I think it scares my office staff when I do that. But there is no choice.

suzy pepper said...

I'm sorry you had to deal with that. I hope she's okay.

vicki said...

what a blooming idiot! i was having a full blown asthma attack and called my doctors office and was told to go to ER. did. their office called ahead and i didn't wait at all. it pays to call the doctor and let them know.
i think she deserves another doctor, not one that cared enough to talk to me on the phone.

Anonymous said...

Grumpy,

Incidentally, if something like this happens again, call 911 anyway.

Give them *YOUR* phone number and the time of the call. It also may help not to answer any more incoming calls for a few minutes, too. (Not that that should be a problem while you're on the phone with 911.)

They can usually get the phone company to check their billing records fairly quickly. (All calls, even local calls that won't actually be charged, produce a billing record. They can identify the last number to call you, or a specific call given the date/time.)

It can take them 15 minutes to an hour, but I suppose it's better than nothing.

aek said...

Two things (other than that I'm so sorry - that's really rough)

You might consider adding a "quick script" response to statements like that (won't go to ED/call 911) with the reply that "OK - I just need your address and phone number to create a medical record/ patient account." And as soon as the person gives enough info to track, put 'em on hold and dial 911. Then just keep them on the line until first responders are there. Deception I think is OK ethically when the patient is in apparent imminent danger and initiated the request for help

Two: what she said is pretty clearly indicative of executive dysfunction - a cognitive deficit. I sure wouldn't take it personally or as an insult. Her logic is faulty. Could be Alzheimers, another neurodegen. issue or an acute issue.

 
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