Patient advocates? what does that look like? - page 2

by tewdles 1,838 Views | 16 Comments

I am interested in feedback on this situation... Imagine a mid 20s young woman who likely has PCOS but has not received a definitive dx. Last year, she bled for 8 months and then went to the ER of a large university hospital... Read More


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    I never saw insurance being an issue in the above situation.

    Second- you can not force a doctor to see patients who don't have a way to pay. I would not see a doctor who did not provide care to all.....How many of us work for free ? Why should doctors ?
  2. 0
    Quote from MedSurg32RN
    I never saw insurance being an issue in the above situation.

    Second- you can not force a doctor to see patients who don't have a way to pay. I would not see a doctor who did not provide care to all.....How many of us work for free ? Why should doctors ?
    Some docs and nurses do volunteer, but that is the topic of a different thread.

    Do you think these nurses were advocating for this 27 yr old woman?
  3. 0
    Quote from MedSurg32RN
    I never saw insurance being an issue in the above situation.

    Second- you can not force a doctor to see patients who don't have a way to pay. I would not see a doctor who did not provide care to all.....How many of us work for free ? Why should doctors ?
    Time out for two paragraphs to discuss the above quote, then back to the OP's question....

    This patient is a Medicaid patient, right? The doctor has an option whether to accept Medicaid patients. No one forced the doctor to do so. So this patient was a patient in good standing and pays through a method the doctor in question accepts. If the doctor doesn't like the payment offered, s/he doesn't have to take Medicaid patients. So no one is asking this doctor to work for "free;" the doctor made the decision to accept Medicaid.

    Doctors do accept free cases all the time. They also reduce costs for well-established patients who have gone through some sort of upheaval in income, like a job loss. Medicine simply isn't like any other form of business; there is a thread of morality woven into each day that is absent from most other industries. That's pretty much what the whole universal health care debate was about - I'm not expecting a push for universal toy access or nationwide taxpayer-provided home repair anytime soon!

    Thank you for your patience; now, back to the topic at hand....

    If I were the doctor, I'd be pretty angry that the first two nurses weren't properly documenting and forwarding patient calls, especially if it looked like they were dropping calls on the basis of the patient's form of payment. Nurses are supposed to advocate for patients, and in this case, it appears the first two in particular really dropped the ball. I'm also really uncomfortable with a nurse basically trying to intimidate a patient into being quiet and going away, which is what it seems to me the third nurse did.

    I can understand getting after a patient who's whining about a minor side effect of a medication one or two days out. However, the complicating factor of the woman's heart condition and the fact that by the time she encountered the nurse, the bleeding and cramping had gone on for ten days, plus the lack of documentation and referral of the first two calls all form a disturbing picture to me. For the third nurse to have simply brushed the patient off and then have delivered the "I've been a nurse for thirty years and I'm not going argue with you" verbal smackdown seems like a poor decision compounded by callousness. However, I'm speaking from the HIM/risk management and patient perspectives, since I'm not qualified to speak from that of a nurse, so I may well be mistaken.
  4. 1
    Quote from leslie :-D
    my dtr has been complaining of abd pain to her pcp/clinic x 1 yr, only to be relatively dismissed.
    (they prescribed her protonix, and drew labs)
    recently, she became acutely symptomatic, results coming back as a growth on her kidney and enlarged liver.
    she told me recently left a message at this clinic, to the effect of:

    'you people have ignored my concerns for the past year, even though i insisted something was wrong.
    if you folks don't get your **** together and respond to my immediate needs this time, you're going to be dealing with my attorney, who insists he has a strong case of neglect from your facility.'

    within 5 minutes after hanging up, my dtr got a call back, and all her concerns tended to.

    i was shocked (yet very happy) she did this...
    i didn't think she had it in her, and 'mommy' was getting ready to intervene.

    sometimes you need to do whatever it takes to be heard.

    tewdles, tell her it's time to start kicking a$$.

    leslie
    lol, see leslie, ya done good. Raisin' another woman who takes no prisoners!!
    leslie :-D likes this.
  5. 0
    OP, are we confident that any or all of the persons this patient talked ARE nurses? or are they MAs? or recptionists?
  6. 0
    I thought the same ( are these really nurses except one identified herself as a nurse). In answer to the question the nurse should have given the doctor the message, we have no evidence that the nurse did not give the message, The second time the nurse should have followed up with patient to see if the MD called.
  7. 0
    That is a good question morte...and I wondered it right out loud as well.

    The patient had asked to speak to a nurse each time she contacted the clinic. My experience with this university and its clinics is that they employ some non-nurses, but it is very "professional" oriented...

    Having said that, this young woman had to call the MD oncall over the weekend because the prescription phoned to the pharmacy on Friday evening was incorrect...and the OPERATOR scolded her for not taking care of prescriptions during the work week! So, in my estimation it is entirely possible that not all of the individuals in question were nurses. No nurse = no advocate.

    It is true that I have no idea if the nurse or the doctor dropped the ball...could be either or both...

    This is part of the sad thing for me...
    This young woman has been a patient of this health system all of her life. Her cardiac defect was diagnosed during a study that was being done in their perinatology department during the 6th month of the pregnancy. So she has literally been visiting this hospital and it's clinics regularly since before her birth.

    I agree medsurg, lack of follow up is part of the problem here. I know when I worked in the ambulatory care arena lack of follow up was generally either a result of professional indifference or waaay too much work in a day. Personally, I thought it was more indifference... but that would reflect my professional priorities and may not actually reflect the "truth".


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