Compassionate Care, or Business as Usual?

1314902_medical_doctorCompassionate Care, or Business as Usual?

     About a month ago an acquaintance went to her physician for a checkup and found that her blood pressure was very high, 180/100. Since this was uncharacteristic, both she and her physician were alarmed. He recommended blood work, an echo cardiogram and an aortic ultrasound.
She made appointments immediately at a Radiology Center and within a few days her blood was drawn and the cardiac testing was done. She anxiously waited for the results which were to be interpreted from the lab test data and sent to her physician by the Radiology Center’s contracted cardiologist. And she waited. She asked her physician’s staff several times over the next week about the results. They hadn’t been sent. She found out the name of the cardiologist and called his office only to learn that the data was still sitting on his desk. Initially a power outage was blamed for the delay; then the receptionist admitted the cardiologist had been out of the office for 5 days without coverage and stated that if “she had done the tests at his office instead of the Radiology Center, they would have been interpreted already.” (Ouch.)
My acquaintance waited. She called her physician’s office again and again, and finally after nearly 2 weeks of waiting, the cardiologist faxed a cursory and succinct report. All was OK – but for over 10 days my acquaintance was highly distressed and anxious waiting for results. I was appalled. How could this be an acceptable standard of care? It was time to do a little investigating.
      In NY State, only cardiologists with certification can read and report the results from data collected by a technician doing ultrasound tests. Although the technician may be well qualified to interpret the results, he or she can not inform the patient or a requesting physician of the outcome. The technician does, however, have the responsibility of reporting a result that shows a life threatening condition, for example, if heart function is exceeding compromised, and alerting emergency services to the need for immediate intervention. Otherwise, interpretation of results can only be done by a certified cardiologist who then transmits them to a primary care physician. According to state regulations, cardiologists have a 15 day window to report results, so a patient can be left nail biting and not knowing outcomes for over two weeks. If a cardiologist chooses to service his or her private patients before patients with data from a free standing radiology center, even if he or she is contracted, and paid both by the radiology center and the patient, that’s his prerogative, as long as the 15 day window from a testing date is met.
      So, let’s look at what’s wrong with this picture. It’s 2013. Everyone I know walks around with a phone capable of transmitting, receiving, and storing more information than a person living in 1913 was exposed to in a lifetime. There’s no excuse for being “absent” from an office and being unable to read test results from patients and return them in a timely fashion to requesting physicians. Maybe 20 years ago, but not now. It can all be done, in the name of expediency, by computer, without fax machines and without paper. It is only the lack of concern for patients that prevents this technology from being utilized, since evolving protocols increasingly include using computerized information transfer. The current federal government mandates are moving us to a computerized medical records model, so that any treatment center a patient visits has access, with permission, to that patient’s current medical status. Of course computers can be used to transmit and read test results, if a physician is co-operative and has the patient’s best interests in mind. The cost is not an issue. And here is the question at the crux of our story: what is missing in our lightning speed world of high tech medicine? We have the capacity to share information instantaneously that impacts patient wellbeing – why does the system break down?
      To find an answer that makes sense, we have to look at the breakdown of compassionate care and communication throughout the system. The cardiologist just didn’t care enough to attend to the report, he wasn’t concerned that a patient was awaiting a result he could have read and sent to a physician in very little time, all from the comfort of a computer outside of his office. This can’t be the first time the cardiologist has acted like this, but the Radiology Center continues to keep him under contract – he at least fulfills the letter of the law. The physician’s office continues to refer patients to the Center when this isn’t the first (and won’t be the last) instance of slow returns. Who cares enough and communicates that compassionate care doesn’t look like this? I recommend seeing an older movie with William Hurt called The Doctor. Perhaps if more physicians had the experiences their patients have, things would change.

Next week: A look at how we can begin to work with physicians and system components to amplify communication and compassionate care
Posted by Ellen

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