Monday, March 23, 2015

How can we do so poorly?

Chistian Gausvik, one of our Telluride Patient Safety Camp participants last summer, sent me a note on Facebook:

Wanted to share a piece with you that I recently had the somewhat unfortunate inspiration to write.

He titled it "7 Months Out." Excerpts:

In the same 7 months since I left the conference my grandfather has been struggling with constant symptoms that seem obviously to point to a bladder or prostate cancer. Following along as a family member I can see the frustrations our system causes. He’s a sharp guy and my family is well educated – though not medical professionals – and still everyone (myself included) has been confused through the entire journey. Assured it was a bladder infection he pressed on through several rounds of antibiotics eventually undergoing a bladder scope and further blood testing. All the while never informed of any possibility beyond a unitary tract infection. He encountered physicians in the hospital and outpatient setting nearly a dozen times throughout these months. The communication and hand off between doctors was poor, the system was muddled with confusion and communication was nonexistent.

After 4 rounds of attempting to treat the symptoms as a UTI, after an X-ray, a scope and multiple sets of blood work and still no answers we switched providers. A repeat of the initial scope revealed a very high grade anterior prostate cancer – understandably missed by routine screening but unforgivably missed by 7 months of encounters with the healthcare system. Seven months of taking pills, having side effects, of changing his lifestyle, of making appointments, of collecting medical bills and finally a repeat of a test that was initially done months prior reveals the diagnosis that should have been obvious all along. 

How can we do so poorly? We do not communicate well, we do not follow patients well and we just don’t always take good care of people.

It terrifies me that I am working my way towards a career in a system that does such a poor job at times, because I only want to do the best to treat my patients in the best possible way. I won’t let it terrify me though, rather inspire me to do better, to communicate, to listen, to speak up, to find and learn from errors. I will do better.


Anonymous said...

2 reasons: the system is built for the system & doctors/admins convenience not the patient and its built to maximize profit not take care of sick people.

Anonymous said...

In my practice when a patient comes in for the second time with the same complaint I pull up all the e stops.
It is both expensive and uncomfortable to seek care. The patient must take time out of their day, and with any kind of insurance there are those co-pays.

I usually start with a broad but simple work-up. If the pelvis is the site, we'll do a urine (a great cheap comprehensive test), exam, heme, labs and probably ultrasound. Pertinent negatives are important. If I can't find a problem then a second set of eyes is often helpful.

It's a rule that has paid off many times. Second time, same complaint, pull up the stops.