tag:blogger.com,1999:blog-5883634615775822475.post981509788957257291..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: To err is humanGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-5883634615775822475.post-27023797975891727672013-06-16T16:38:45.685-04:002013-06-16T16:38:45.685-04:00I recently ordered an echocardiogram without stres...I recently ordered an echocardiogram without stress test rather than with the stress portion --felt exactly the same way! <br /><br />Similarly the patient should have known the test they were meant to go for (and didn't!).<br /><br />Unfortunately, the cost to "society" is that of one extra echocardiogram and the patient's time/delay to diagnosis (fortunately the stress test was negative).<br /><br />I tell myself that my penchant for attempting to avoid ordering truly unnecessary testing makes up for this in the end...you win some, you lose some. We are only human.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-49875065855703904982013-06-11T12:53:33.604-04:002013-06-11T12:53:33.604-04:00Thank you Dr. Grumpy! See, that just goes to show ...Thank you Dr. Grumpy! See, that just goes to show that us pharmacists need to be more assertive sometimes. I think it was an old school pharmacist thing to just eat the cost of physician's error rather than hearing about how difficult it was going to be for the patient to go back to the doctors office.. blah blah blah. <br />Leah https://www.blogger.com/profile/12969694049187510812noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-51674831315382367892013-06-10T22:03:32.317-04:002013-06-10T22:03:32.317-04:00Dr. Minerva- I have reimbursed patients for co-pay...Dr. Minerva- I have reimbursed patients for co-pays. All were in situations where I meant to sign for DAW, and accidentally signed for generic, in epilepsy patients.Grumpy, M.D.https://www.blogger.com/profile/09858110332436246760noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-70056108725848027082013-06-10T20:31:20.537-04:002013-06-10T20:31:20.537-04:00If you order the correct test, and the insurance c...If you order the correct test, and the insurance company later denies it, for whatever reason, it is totally the patients responsibility. <br /><br />Patient's have a responsibility to their own care. I'm sure your office makes them sign something saying they are responsible for costs not covered by insurance. <br /><br />What is interesting to me, is who pays when the doctor writes the wrong prescription and the patient gets it filled at the pharmacy? Usually the pharmacist ends up eating this cost because they don't feel like dealing with the hassle. (read: complaining patient) I think in that case the doctor should refund the patient their copay.I think this happens almost NEVER. Leah https://www.blogger.com/profile/12969694049187510812noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-47522426849650593042013-06-10T10:20:22.935-04:002013-06-10T10:20:22.935-04:00This has probably been said already ... but the pa...This has probably been said already ... but the patient certainly has a role in all this. When I have had fancy expensive tests done I'm aware of what body part is being tested. If I showed up for a lumbar exam and went head-first into the scanner I'd be calling time-out.<br /><br />The system needs built-in redundancies such as those we use to double-check and confirm patient identity and, in the case of surgery, the side & site of the procedure. The imaging center/hospital should implement a policy where the tech does a verbal confirmation with the patient: "You are here for a [fill in blank imaging study type] on your [fill in blank for body part & side when applicable.] Does that sound right?"Jen in Cincinnatinoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-67192572778687268742013-06-09T12:05:12.750-04:002013-06-09T12:05:12.750-04:00In that scenario you have some options - you can a...In that scenario you have some options - you can appeal the insurance company's decision, you can talk to the hospital and explain the situation and perhaps get the fee reduced (since we all know hospitals inflate the crap out of any bill when dealing with insurance companies). You don't need to eat the cost on a test you felt was necessary, but you do need to advocate for your patient when they end up getting screwed by the insurance company. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-71196374551293521472013-06-08T23:53:50.401-04:002013-06-08T23:53:50.401-04:00Okay, but what about the scenario I suggested: I o...Okay, but what about the scenario I suggested: I order the correct test, but afterwards an insurance company says it wasn't necessary, and refuses to pay for it. Who pays for it then? Should I? Should the patient?Grumpy, M.D.https://www.blogger.com/profile/09858110332436246760noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-13867853197972312792013-06-08T23:41:11.872-04:002013-06-08T23:41:11.872-04:00You absolutely should eat the cost. That is the l...You absolutely should eat the cost. That is the literal price you pay for making errors. As the comment above says, that is part of doing business. Why on earth should the consumer pay the cost of your error? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-53869151987875437782013-06-08T05:52:39.612-04:002013-06-08T05:52:39.612-04:00Like every business, it is factored in. In the re...Like every business, it is factored in. In the retail business it is called shrinkage. In the bar business it is spillage, waste happens as a natural part of life and any profession. The Drunken Bar Ownerhttps://www.blogger.com/profile/12728558125579768519noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-28111390319321659832013-06-07T20:39:23.951-04:002013-06-07T20:39:23.951-04:00Doc, have you tried to buy a pencil without an era...Doc, have you tried to buy a pencil without an eraser lately? As I told my surgeon after my scary bout with C-Diff, there is a message in the rare availability of eraserless pencils. We are expected to screw up. Welcome to the human race. Thankfully most scrwewups are painless in the end. BobFnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-44191890600621077272013-06-07T17:07:53.412-04:002013-06-07T17:07:53.412-04:00I agree with Anon1:52, however the patient shares ...I agree with Anon1:52, however the patient shares some fault since I would hope that you told the patient what test you were ordering.<br /><br />Packer, when someone asks which pharmacy I want my rx sent to, I say that I prefer a piece of paper in my hand. Docs will give you a hard copy of your prescriptions if you ask.WarmSockshttps://www.blogger.com/profile/12192702662231361355noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-83424985189259169592013-06-07T13:52:25.823-04:002013-06-07T13:52:25.823-04:00"If a doc orders the wrong test, should he ha..."If a doc orders the wrong test, should he have to eat that cost?"<br /><br />Yes. That's how it works in most businesses, including mine: If I make a mistake when I spec the ink color or paper stock so the job has to be reprinted, I eat the cost, not my client. This is standard business ethics.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-49542514542028890732013-06-07T01:29:58.355-04:002013-06-07T01:29:58.355-04:00Doc, in medicine (especially emergency medicine) ...Doc, in medicine (especially emergency medicine) mistakes can be fatal. I had an instructor once say "if you haven't made a fatal error, you haven't been working very long." While I think that's a bit extreme, I agree with the idea behind it: that humans make mistakes and when it's life or death, people may die.<br /><br />No need to beat yourself up over a simple mistake. You were good enough to see and correct it; IMHO that puts you ahead of a LOT of other providers.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-18981399121426311242013-06-06T22:46:02.659-04:002013-06-06T22:46:02.659-04:00A once in a blue moon mistake is totally forgivabl...A once in a blue moon mistake is totally forgivable. Excessive mistake making is not. Nor is over ordering tests because it's easier than using one's brain to figure out what's wrong with a patient.<br /><br />I think you are doing just fine, Dr. G. Keep up the good work.<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-69677080384965567192013-06-06T22:36:44.186-04:002013-06-06T22:36:44.186-04:00Thank you Dr. Grumpy.
What a wonderful idea and ex...Thank you Dr. Grumpy.<br />What a wonderful idea and example that all parties with a stake in health might have a calm dialogue on such an important subject involving so much time, energy, and money. <br /><br />Difficult? Sure. Complex? You bet. We Americans have always believed that one of our key traits we possessed was a "can do" attitude, whether it was to span the oceans or outer space. Keep up the good work.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-48482676856716090472013-06-06T21:00:49.941-04:002013-06-06T21:00:49.941-04:00Once my doctor was supposed to order 80 mg for 120...Once my doctor was supposed to order 80 mg for 120 days, and wrote 120 mg for 120 days. The pharmacist caught it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-23790302642898837052013-06-06T20:59:28.657-04:002013-06-06T20:59:28.657-04:00Several years ago I was ill and the doctor couldn&...Several years ago I was ill and the doctor couldn't diagnose me, and ordered some special blood test. The lab ran the wrong one. She sent me back. They ran it wrong again. She sent me to the hospital and told me to meet the tech myself and explain very clearly what the test was, which I did.<br />They ran it wrong.<br />The test was never done.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-71055808672272636502013-06-06T17:21:10.915-04:002013-06-06T17:21:10.915-04:00As a patient, I'm the biggest pain in the ass ...As a patient, I'm the biggest pain in the ass any doctor has ever had to treat.<br /><br />Why?<br /><br />Because I question EVERYTHING, and demand to understand what's being ordered/done/prescribed and I won't nod my head or utter "I understand" until I really do.<br /><br />One thing I don't do is ask Uncle Google about every twitch/rash/lump/pain I get. For that my Primary is very grateful...but for my questioning, she says I sometimes give her a headache.<br /><br />Tough. It's my body, and no one is going to alter it - with anything - unless I know why.<br /><br />On the plus side, I've gotten pretty well-versed in medical terminology over the years. Wait, that's not a plus because it means I've been to numerous doctors with various ailments over the years.<br /><br />Sigh...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10379738538085563322013-06-06T16:51:48.972-04:002013-06-06T16:51:48.972-04:00I'd take the $0.000000076 if it would make you...I'd take the $0.000000076 if it would make you feel better, but I'm not an American citizen so I cannot be of help in the matter.<br /><br />Seriously, though, I do wonder how many people have had an erroneously ordered test and it was incidentally found that something was amiss that hadn't even been considered when the erroneous order was placed.Steeny Louhttps://www.blogger.com/profile/11886224738812704532noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68688965055478592602013-06-06T15:32:35.025-04:002013-06-06T15:32:35.025-04:00Two wrong tests in 10 years is probably much bette...Two wrong tests in 10 years is probably much better than average. Keep up the good work doc. Oh, and don't worry about paying me back. I probably owe you for how much I've enjoyed your blog.Jedi Master Ivyannoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-12325649028727303922013-06-06T13:38:06.082-04:002013-06-06T13:38:06.082-04:00If it makes you feel any better, I personally forg...If it makes you feel any better, I personally forgive you. Keep the $0.000000076. Can't speak for the 20K unhired teachers, but I suspect that even if the school systems had the extra money, all of it would go to the superintendents and their cronies anyway, so who cares if you made a small mistake?Hildynoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-73118387080244363292013-06-06T13:19:06.888-04:002013-06-06T13:19:06.888-04:00We can't afford insurance and don't qualif...We can't afford insurance and don't qualify for Government Medical, so we don't get tests done.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-64774533440582231852013-06-06T13:13:02.169-04:002013-06-06T13:13:02.169-04:00I cannot tell you how many errors my husband has c...I cannot tell you how many errors my husband has caught because he is his own advocate and will speak up if something isn't right. No matter how pissy the person who wants him to sign those forms gets. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-83717151642382260122013-06-06T13:10:56.652-04:002013-06-06T13:10:56.652-04:00One of my patients had a chiropractor order a tota...One of my patients had a chiropractor order a total spine MRI (How that got approved by the insurance company I'll never know)and in the process found a couple of aymptpmatic incidentalomas, wound up have a thyroid biopsy, scan etc. and an CT guided needle biopsy of an abdominal lesion, both of which were negative. That unnecessary MRI cost probably 50,000 bucks by the time it was over.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-52534855729919798562013-06-06T13:01:07.974-04:002013-06-06T13:01:07.974-04:00I agree with Packer...I agree with Packer...bobbiehttps://www.blogger.com/profile/14353836074794786357noreply@blogger.com