Advice on Patient Relations

Most people who go to the doctor or hospital do so with reluctance, often even with trepidation. Many, but not all, doctors and nurses understand that. Sadly, most receptionists do not. I never really thought much about that until Friday, when I was becoming stressed out after learning that parking would cost us $10.00, my four and a half-year-old son was starting to get restless after a 45 minute car ride and I needed to find the nearest Temple of Relief.

I don't think that it was the receptionist's having to work the day after Thanksgiving that made her rather unpleasant. It might have added to her lack of compassion for nervous patients. When I think back to other doctors' offices, I recall some of the receptionists and clerical office staff members who actually made me change doctors. (I even blogged about it last year in the post, "Firing Squad.") When I've interviewed some of Connecticut's top doctors, many of them credited the success of their practice to having a "truly wonderful team" or "fantastic office staff." One doctor noted that they are the first people patients see and their friendliness makes a huge difference. He's absolutely correct.

My gripes in the aforementioned blog were more about their lack of cooperation than their lack of friendliness. Over a six year period, different receptionists for the same doctor at separate practices failed to tell him that at least two patients left messages for him. One patient had been released from the emergency department just a few days before. He never called them. Either he didn't get the messages or he is just an uncaring doctor (and there are some like that). My biggest issue was with a doctor who refused to call my insurance company to authorize a treatment. This came up because I had a bill for $1,600 for out of pocket treatment. As the bill kept running up, I assumed that his outsourced billing group messed up yet again. I was unaware that my insurance policy no longer covered the treatment. I gave him the information that the insurer needed, in addition to a telephone number. His office staff was quite large and they were always chatting with each other. The receptionist had ample time to read many books while "working." The irony is that he asked me to settle the bill by making an offer so that he would get something for the treatment. I offered him just under one-third the amount and he accepted it. I was pleasant about paying him (and why not since I probably gave him more than the insurance company would have reimbursed him had the treatment been covered?). After that, I fired him and his replacement turned out to be exact opposite of him. I lucked out.

Recently, my mother had a nightmare of a health issue. Her first doctor, who represents a division of Stamford Hospital, misdiagnosed her big time. In 10 days, he saw her walk in with some discomfort and ended up in a wheelchair and bedridden. He refused to give her a pain killer. He told her that she must be in bed (which she did) and that she "would just have to live with the pain." I had bad vibrations about him from the get-go. Three doctors later, she finally had the right diagnosis, but it was with "I think I know what it is" and that doctor threw her hands in the air and put the onus on us to find a specialist who might be able to treat her very rare condition. The Internet wasn't helpful, even my three go-to sites: The Mayo Clinic, the CDC and the NIH. I picked up the phone to get leads on medical centers, clinics and research centers that treat it, and got the runaround about how they don't recommend doctors. I reiterated my purpose. I finally got a lead to an organization and heard the same spiel. That receptionist finally agreed to let me send an email to her and she would pass it along to the board of the organization. She sent me the names of two doctors, one in New York City and one in Boston, who have had experience with this disease. Meanwhile, I found the names of two doctors in Washington, D.C. and one in New Haven. That's how rare the disease is.

When my mother called for an appointment, she was told there was a five to six week wait. I spoke to the practice manager rather than the appointment maker and found out what we had to do in order to make her a priority patient. (I remembered another top doctor who told me that at his practice, they try to see patients quickly so that that they don't have to be in pain.) What was required? We had to fax her medical records (from two hospitals) and a referral on their form marked "URGENT." I took her 75 pages of medical records and created a four-page Excel spreadsheet in which I logged the dates of visits, levels of pain, whom she saw, diagnoses, treatments and outcomes. She got a call from the practice manager who said that the doctor could see her in two days. What a difference! And he was the only doctor who did a biopsy to verify his diagnosis.

The moral of the story is that everyone in a health care practice should know what he or she is doing and do right by the patient -- even an outsourced billing group.