Irritated about making an appt.

Agnus · Feb 26, 2003

Some times things are too complicated to just give the scheduler a reason. She should respect that I may not want to discuss it with anyone than the Doc.

Some things are too personal.

I may need to see him about something that never appears ever on the chart. It is between me and the Doc. This happens more than many would susupect. It truly is None of anyone's business and this possibility needs to be considered with every appointment.

The paractice belongs to the MD no one else. He hires you to do certain things but there will sometimes be aspects of his business or practice that you are not privy to inspite of the fact that you may know more about him than his wife.

hogan4736, BSN, RN · Feb 26, 2003

things discussed NOT subsequently put on the chart????

and you're telling me that he can afford to outsource every office function (billing, chart review,etc), and no one in the office knows anything??? sounds hard to believe, and awful expensive for the practice..

also sounds risky to me...every doc/pa/np/rn will smartly chart everything that was discussed, to protect the patient and the provider...

that's just me and my quirkiness about wanting to keep my nursing license...

let's say you discussed a reportable (to the state health dept) STD, and it wasn't charted...not charted means not reported...

or let's say you were too embarassed to discuss constipation w/ the front office staff, and then "secretly" discussed it w/ the doc; and you convinced him not to chart that. 6 months later you find you have prostate cancer, and your previous constipation conversation/recommendations weren't charted...that could spell trouble...maybe far-fetched, or a bad example, but you get the point.

But I implore you, everything done by or discussed w/ the doc, should be documented.

sean

kids · Feb 27, 2003

All of this makes me really thankful for the system used at my PCP's clinic. When you call for an appointment the first thing you are asked if you are a new or established patient, the next question is do you feel you need to be seen urgently or is this appointment for a latter date. Depending on your answer established patients are transferred to the specific Doc's triage nurse or nurse coordinator, she gathers the info on why you need the appointment then hands you back to the scheduler after telling them how soon you need to be seen and for how long. At that point scheduler collects your insurance info and makes the appointment. This is at a 115 provider multi-specialty clinic.

I have picked up a couple of statements made in this thread that I find very disturbing. I am surprised no one else has mentioned them:

Originally posted by RN2B2005 (post #38)
...When the receptionist asked you what was going on, she was likely looking for something--a definitive symptom, like chest or abdominal pain--that would allow her to override her schedule or reschedule another patient and get you in to see the doctor that day....

I have a hard time accepting that a Physicians off would accept the liability on a person without medical training (and it would be outside scope of practice of a student nurse) triaging patients and determining the level of urgency for an appointment.

Originally posted by hogan4736 (post #33)
...the janitor often translates ALL of the history in EVERY ER in Phoenix...

I also have a hard time believing this, in a private hospital maybe but state/federally funded hospitals are REQUIRED to provide translators for free. The *only* hospital (400+ bed) in my county has 24/7 in house Spanish & Russian translators.

Originally posted by hogan4736 (post #41) ...Many people will see your chief complaint (including the janitor, who in our clinic, will be translating EVERYTHING)...

Sorry but I feel your clinic is doing a huge disservice to the patients it serves. I feel your clinic has a duty to the community is serves to employ medical staff who speak the language. Given the high percentage of non-English speaking members in the community how can it be that none of them have any medical training.

While the "need to know" may extend to receptionists, schedulers, medical records etc by NO stretch of the imagination does it extend to a janitor.

hogan4736, BSN, RN · Feb 27, 2003

kids-r-fun

I have worked in 4 ERs in Phoenix, and all of them use other family members,other patient's family members, janitors, or anyone they can find. Honest to god's truth.

We have one state hospital, I haven't ever worked there, so I can't speak to what they do, but I have my suspicions...All of the rest of our 14+ hospitals are privately owned... Over my last 8 years in the ER, I would go on record saying that the housekeeping staff do the lionshare of the translating...

A couple of points related to this:

1) oftentimes there are 1 or 2 staff that speak Spanish in the ED, but are extremely busy, so the doc grabs the housekeeper (we have a 24/7 dedicated housekeeper for the ED)

2) sometimes only one nurse/cna in the whole hospital speaks Spanish, and will go to other floors to help translate, if available.

3) This is likely to make me unpopular, and is slightly off topic, but if I MOVED to Germany, wouldn't it be arrogant of me to EXPECT that the hospital to have a 24/7 English speaker to translate...How is it the hospital's responsibility to translate for someone who has lived in the USA for 20+ years....And before you think I'm exaggerating, DAILY I encounter someone who has lived in Phoenix for 10-20 years and "me no speaka tha english"

I'll argue that it's the families' responsibility to bring someone in that speaks good English to translate (think about some of the points that have been made on this thread, a 3rd party translator is someone else knowing your buisiness!! :))

4) many families prefer using their EIGHT year old to translate complicated (or embarassing) medical histories...

oh, and to your first point about MA's possibly doing triage over the phone...I agree w/ you, but it goes on in offices all over Phoenix...For that matter, I know of several MA's giving IM Rocephin and other Abx, placing Foleys, etc...

sean

kids · Feb 27, 2003

I have no problem an MA doing triage with supervision, or the invasive procedure you mention, as it is incorproated in their 1 year of training here in WA. I have reread RN2B2005's post and at do not see where she indicates she is an MA, she does however offer her perspective from "5 years of medical reception" (if I have overlooked her mention of being an MA I do apologize and would appreciate being directed to the staement).

Any hospital that accepts Medicaid or Medicare funds are subject to State and federal rules, even if they are privately owned:

http://www.hhs.gov/ocr/lep/fact.html

http://www.hhs.gov/ocr/lep/press.html

http://www.hhs.gov/ocr/lep/guide.html

an excerpt, copied and pasted from the 3rd link:

The lack of language assistance capability among provider agency employees has especially adverse consequences in the area of professional staff services, such as health services. Doctors, nurses, social workers, psychologists, and other professionals provide vitally important services whose very nature requires the establishment of a close relationship with the client or patient that is based on empathy, confidence and mutual trust. Such intimate personal relationships depend heavily on the free flow of communication between professional and client. This essential exchange of information is difficult when the two parties involved speak different languages; it may be impeded further by the presence of an unqualified third person who attempts to serve as an interpreter.

Some health and social service providers have sought to bridge the language gap by encouraging language minority clients to provide their own interpreters as an alternative to the agency's use of qualified bilingual employees or interpreters. Persons of limited English proficiency must sometimes rely on their minor children to interpret for them during visits to a health or social service facility. Alternatively, these clients may be required to call upon neighbors or even strangers they encounter at the provider's office to act as interpreters or translators.

These practices have severe drawbacks and may violate Title VI of the Civil Rights Act of 1964. In each case, the impediments to effective communication and adequate service are formidable. The client's untrained "interpreter" is often unable to understand the concepts or official terminology he or she is being asked to interpret or translate. Even if the interpreter possesses the necessary language and comprehension skills, his or her mere presence may obstruct the flow of confidential information to the provider. This is because the client would naturally be reluctant to disclose or discuss intimate details of personal and family life in front of the client's child or a complete stranger who has no formal training or obligation to observe confidentiality.

When these types of circumstances are encountered, the level and quality of health and social services available to persons of limited English proficiency stand in stark conflict to Title VI's promise of equal access to federally assisted programs and activities.Services denied, delayed or provided under adverse circumstances have serious and sometimes life threatening consequences for an LEP person and generally will constitute discrimination on the basis of national origin, in violation of Title VI. Accommodation of these language differences through the provision of effective language assistance will promote compliance with Title VI. Moreover, by ensuring accurate client histories, better understanding of exit and discharge instructions, and better assurances of informed consent, providers will better protect themselves against tort liability, malpractice lawsuits, and charges of negligence.

kittyw · Feb 27, 2003

Originally posted by hogan4736
I have worked in 4 ERs in Phoenix, and all of them use other family members,other patient's family members, janitors, or anyone they can find. Honest to god's truth.

We have one state hospital, I haven't ever worked there, so I can't speak to what they do, but I have my suspicions...All of the rest of our 14+ hospitals are privately owned... Over my last 8 years in the ER, I would go on record saying that the housekeeping staff do the lionshare of the translating...

Just because it happens doesn't make it the right thing to do. Also I have a really hard time believing that the use of janitorial staff is a regular occurance for the ENTIRE city of Phoenix. See above regulations. There must be some form of outside inspections that would detect this lack of services and enforce changes. Even if it's just the use of the AT&T translation services. We have to provide that at a minimum for no cost to the patient. If someone hasn't sued by now, it is prime time for them to do so.

hogan4736, BSN, RN · Feb 27, 2003

kids,

I reread her post as well, and there is no mention of her being an MA...But MAs can do triage and give antibiotic injections??? Really???Not legal in AZ, though it goes on...mmm

Look, I'm talking reality...I know of one hospital (an inner city, predominately hispanic neighborhood) that employed (when I worked there 3 years ago) that hired a "patient liason" from 2-12 4 days a week...one person only...now, she was from Mexico, and she happily translated. That's 1/14...After posting earlier, I made some calls...Not one hospital has a translator 24/7, and only 2 have one part-time...All others have access to the language line, but I've heard, "I'd rather have housekeeping do it, they're right here." or "The language line is too expensive"

The law says what it says, but I'm talking reality...Look up the E.M.T.A.L.A. law as it pertains to transferring care, and how many hospitals have actaully been held to that standard, when an allegation arises

The federal laws notwithstanding, it's not realistic to make a hosiptal that is already in the red, to hire a translator 24/7, when that salary (188 hours @ 10/hr) could hire 2 FT nurses, in this age of a nursing shortage...

And it's not right to ask the hospitals to translate for an illegal immigrant, when that person came to this country of his own free will, and refuses to learn the language and assimilate...My grandfather emigrated to the USA legally from Ireland, and didn't allow Gaelic to be spoken in the home until English was learned (and he had a basic understanding of English before coming over), anyway

besides, what if a translator calls in sick? Do we get slapped w/ a federal fine each time??

hogan4736, BSN, RN · Feb 27, 2003

Originally posted by kittyw
Just because it happens doesn't make it the right thing to do. Also I have a really hard time believing that the use of janitorial staff is a regular occurance for the ENTIRE city of Phoenix. If someone hasn't sued by now, it is prime time for them to do so.

First of all, you are in the mood to pile on me kitty...

second, unless you have worked in Phoenix recently, you have no idea...And I'm just talking about the hospitals, not speaking to the hundreds of offices. I've been a patient in this valley for 20+ years, and have seen docs and nurses ask housekeeping, and OTHER patients' family members.

You may not agree w/ my beliefs, but I'm not making this up guys.

some docs muddle through, but some things get lost...is that a better plan? I'm not just trying to get a rise out of the board here...I know what I'm talking about...And I worked UCSD trauma for a year, and it was the same way on some nights.

And there is an Hispanic nursing shortage in Phoenix...We have a school RN (white guy) trying to recruit Hispanic males/females to go into nursing rught out of school

thanks for the time, sorry to ruffle feathers, or lead you to believe I am making this up?!

sean

kittyw · Feb 27, 2003

I have been nothing but kind to you Sean.

If I am in disbelief, it is because the action you mentioned is NOT an occurance at any hospital I've been in. I never said you were making this up - now did I? It's just hard to believe that an ENTIRE city would operate where they rely on JANITORS ALL the time. And where I am now would much rather pay for the translation service than for any fines it may accure. Plus they offer medical Spanish classes for free to all employees and have established a list of people that donate their time to translate. And for you to say it is common in all hospitals when you have only worked in 4 - how do you know? You're not in all of them. As I can only talk for the ones I've been in - not the entire city.

hogan4736, BSN, RN · Feb 27, 2003

medical Spanish doesn't cut it kitty...it's a good idea, and I've taught it at several hospitals (yes I have been a Spanish teacher, and FYI am married to a Mexican National) much get's lost, and if you break out w/ the terms you've just learned in you medical spanish class, you'll likely get a whirlwind of Spanish back at you, above the level of any introductory class...

bottom line: Families need to bring in a translator w/ them. Might not be a "PC" solution, but it is the most realistic (esta de acuerdo mi esposa...my wife agrees)

sean

p.s. there is no "outside entity" that will police the 24/7 providing of a translator...

and what about french and other languages that come in...not to be a smart aleck, but I would guess the same federal laws apply to ALL languages? where is the line drawn...sign language too

kittyw · Feb 27, 2003

Last time I looked the AT&T line did a ton of languages. We're required to have signage in many (forget the exact number but it's like 24) languages telling patients of the availablity of translators. So yes - we provide services for many different languages not just Spanish (but that's what you used in your example.)

How your entire city got away with not providing these services - I have no clue. And again... just cause it happens doesn't make it right.

hogan4736, BSN, RN · Feb 27, 2003

kitty, with all due respect, if you read a previous post of mine from page 4, I mentioned the language line...I also stated, in my experience, most would rather use housekeeping, or muddle through...that's just reality...I never said it was right or wrong, just that's what's happening...There's a lot of resentment against Spanish speakers (only) in the hospitals here. That's a reality. And I have seen an occasional memo asking the docs to cut down on the use of (Spanish) AT&T lines, as "they are expensive, and there are in house people to use"

sean