The other day I had a patient (and family) that sort of reminded me of a recent post by Whitecoat. A healthy woman in her twenties came in for a day of vomiting, diarrhea, and abdominal pain. She had been seen in our ER the day before and given a diagnosis of viral gastroenteritis after normal labs, fluids, and resolving pain. It had now gotten worse. Thus, my colleague ordered an Ultrasound of her gall bladder since she seemed to localise her pain in the upper abdomen. Labs again normal, ultrasound normal, pain improved. I was about to discharge her when her mother said – “I want a Gastroenterologist to consult”. I told her that would be fine – as an outpatient if the symptoms were not better in a few more days. No, she wanted it NOW. I was THIS close to arguing as to why I did not think it was necessary but only said – “even if I get one to see you, they probably won’t do anything different and will wait to see how you do later this week”. They still wanted demanded one. Fine I was just not up for an argument, she had insurance, so I figured I might be able to get one to see her as a “feed the Bulldog” consult.
Guess what happened. The GI guy came in, and took her for an “emergent” EGD (upper endoscopy)! Result negative. Then he ordered an abdominal CT! Also negative. The patient stayed in the ER for more than 12 hours and basically got a totally elective workup. Discharge diagnosis – viral gastroenteritis. Hmmmm. Sounds familiar! Now there is a lot of health care dollars well spent……
GI has to pay their malpractice fees also…
So she got a +/- $20,000 w/u for AGE. The health care system has evolved into this “the customer is always right” mentality. Administrators etc. keep telling us this, and here is an example of the end result.
When mad momma goes to med school, she can order the GI consult. We can not let the monkeys run the asylum any longer.
And the family apologized and sent you a fruit basket the next day?
Steve
Hopefully the will send me all “5’s” on their Press Ganey survey!
you should send them a nice fruit basket with a note asking them is the cost was worth it
My hospital likes people to be asked “is their anything else we can do”
I don’t think that I have ever asked, but I see signs for it is staff areas.
This is why they should go back to being patients. They never should have been allowed to become customers.
When does the hospital ask the nurses or docs what it can do for them? Or ask the nurses and docs what it can do for the patients?
We spend to much time catering to the wants of family members and not enough time addressing the needs of our patients.
“is there anything else we can do”
This is bs. I am not a barista. If you want your nonfat, no whip dilauded with an extra shot, go see pain management.
We cater to the “wants” of the patients while negating their true needs. Patients are now like 3 year olds in a candy store. They want it all, but do they need it ? We all know the answer to this, sadly its our own governance that let this happen.
My appearances in the ED for past thirty years have been as the consultant specialist called in by the ED staff. Even so, I was sometimes faced with similar insistence by patients. My (totally unauthorized and possibly illegal) response was to tell them that I would order the test, or call in the additional consultant, they were demanding but if the test or consultant did not in the end add anything to the diagnosis/treatment recommendation I had already provided, that I would recommend to their insurance carrier that they deny that part of the claim and require the patient to pay. It was simply amazing how often they decided they did NOT need the additional services.
thats what i loved about my family doc
he made the calls and scheduled personally any apptmts with a specialist after explaining if we were him this is what he would have done
he also when we asked for antibiotics when we had a virus would laugh and say they didnt work for the cold we had and we didnt get a scrip for any
he also would laugh when it was time to get a shot and say this WILL hurt you more than it will HURT me (his emphasis)
sadly he passed away recently…
Since when do consultants show up and take over care of an ED patient who is not an inpatient? That’s weird.
Sometimes for crayzee patients who think the ER=Comprehensive Continuing Care Clinic, the doctors will place a call to a consultant and ask them whatever it is the patient wants them to ask, get them to LOL on the phone (haha, an EGD for N/V x 2 days yeah right!!!), and then tell the patient that the consultant (Dr. Important, the highly respected gastroenterologist) recommended no further testing. Who cares if people are pissed off because they were being inappropriate and we didn’t roll over and bow down to their inappropriateness?
PS: Grow a pair
Well, Nurse K, the problem was is that the patient wanted me to call their PMD (a Dr Important themselves apparently) and ask them for a GI referral – I was hoping the guy would have said to refer her to someone as an outpatient. Instead the guy (who was cross covering)said “GI sounds like a good idea! Have Dr So and So see the patient now!”. Urgh! THEN I hoped the GI guy would see her and say “you have a virus, go home, I will see you in a week if you are not better” but NO! He went and did the damn EDG! And then when it was negative, he ordered the CT. Submarined again. This was a nice consult I am sure for him to pay for his Christmas presents.
so this young woman got her ovaries irradiated for a case of gastro. Good manouvre by GI. What ever happened to watchful waiting and a good clinical exam?
Ridiculous.
I am all for customer service. We can do a much better job of making patients comfortable. BUT only if there is NOTHING more pressing to do. All other patients are taken care of. There are no patient care issues with this patient. This does not appear to be a patient care issue.
This appears to be going well beyond customer service.
ERP,
they will probably not give you 5s, because they probably view you as the ignorant doctor, who did not recognize the wisdom of their treatment. The patient got better. Therefore, what they did worked. This is why people believe in quack remedies. It does not matter that these were not treatments. they only see that they stopped you you from withholding care. Then the patient got better. It is the same when they take antibiotics for a cold – “but I got better after taking them.” They were probably writing in nasty comments in addition to giving a low number.