“A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient.” (Wikipedia)
By Paul Goldfinger, MD, FACC
Normally, when we think of “defensive medicine” we think of doctors ordering needless tests in order to avoid malpractice suits.
But I’d like to point out another kind of defensive medicine — the kind that requires patients to assert themselves as they navigate the minefield of modern healthcare.
Our idea is to establish the Blogfinger Medical School for Patients — Online Campus. We will present a series of sample cases that illustrate how patients can influence the quality of their care. Some will be actual cases and some will be fictitious, based on reality. You can even send us examples but try to keep it all simple — make one or two points at a time. Here is an example:
BFMS Case Study #1: A middle-aged man with chronic asthma takes medication for it. He sees a pulmonologist regularly and has flare-ups on occasion. When he has flare-ups, his doctor almost always treats them the same way, and early intervention prevents worsening.
He gets a cold and then he is awakened from sleep with asthma. He uses his inhalers, but the next morning he is worse, and he knows that he needs a medical intervention. He calls his pulmonologist, but his doctor is off. The person answering the phone says, “The covering doctor will call you back, but he will make those calls late this afternoon.”
The patient says OK, but his condition deteriorates later in the day, and he winds up in the ER.
Analysis: This patient was right to call his doctor that morning. If the covering doctor had called back quickly, more intense at-home therapy might have stopped the cycle, as in the past, and stabilized him without the ER visit.
Ideally, the doctors’ office should ask the patient to come right over and see any of the group’s physicians. Physicians should always try to find ways to help their patients receive care without going to an ER.
Lesson: Sometimes patients must be demanding. This man should have asked to be seen that morning in the office. If the office refused to see him, then he should have insisted that a physician call him back immediately. If that call-back doesn’t come within an hour or so, he would do well to go the ER (or a reputable urgi-center) to prevent the situation from spiraling out of control.
Subsequently the patient should complain to his doctor about what occurred and ask for a strategy that can be implemented as needed at home to reverse a worsening of the asthma. The doctor should provide the needed prescriptions and guidelines in writing, in advance, for when the asthma acts up again, along with written instructions on how to proceed if home therapy isn’t working.
In my opinion, the only problem with Obamacare is that it didn’t create a single payer system. My hope is that will follow in a few years after people get over the ridiculous fear-mongering from those opposing the bill. Already we are seeing people embrace elements of the bill such as preventing prior conditions from disqualifying you from an insurance plan or being able to cover your adult children until age 26.
I suspect my opinion will not be popular in Ocean Grove!!
Thanks Carol. You are a terrific resource. I’m waiting for you to say more about Obamacare. We are staying away from politics on this, but what’s in there regarding quality care??
I love the Urgent Care Center in Northern NJ that’s affiliated with Summit Medical Group. All our doctors are at SMG, so if one of us needs to be seen on an urgent basis, all our info in already in the computer. If we end up full time Ocean Grove residents, I’m hoping to find something similar.
Very important advice; I would add only that anyone caring for a person with memory problems needs to be an aggressive advocate, since the patient can’t. Keep good records of test results, interventions, medicines, and don’t be shy about speaking up to the doctors. Never cede to the doctor or the nurse the responsibility for keeping track of your or your loved one’s health. Too often we are raised to be respectful of doctor’s authority and knowledge; we forget that we are equal partners in this!
Where are the nearest urgent care centers? Stop & Shop had one for a while but it closed. The nearest one I found on the web was Family First Urgent Care, 1910 Highway 35 South, Oakhurst. Are there any nearer?
I’m sorry Froggy (? is this Sesame Street) but I know of no agency or publication a la US News that rates urgicenters. They have been around for about 30 years but have not caught on in large numbers. However soon we will have a huge influx of insured patients with no increase in providers, so a good urgicenter in the neighborhood would be a big asset.
If anyone wants to weigh in regarding this question, please do.
And Froggy: Is it easy being green?
Dear Woe is Me,
Thank you for helping me affirm my strategy of keeping my Essex and Morris county doctors of the past 15 years. I can always get an appointment within a day or 2′ and because my doctor knows me well, if I need another prescription or a different medication, she trusts my judgement enough to call the pharmacy and put in the order.
Good ideas. Now please let us know how to find out if an urgent care unit is reputable. Are there ratings available online?
It has been my experience with doctors in Monmouth County [that] they won’t let you come in to the office. The offices state that if you think you have an emergency, then go to the ER.
They won’t give advance prescriptions. When you go to the ER you have a much higher copay and many of the ER doctors don’t participate in any plans. So you might have to pay the whole bill for the doctors’ services.
This blog continues to amaze me. Thank you for keeping us so well informed on many varied–and valuable–topics.