Patient S. was feeling extremely agitated as she waited to see her new rheumatologist. She had just moved to a new town a few months ago, and her last office visit had been an emotional disaster. She had no idea if she was facing a serious health issue, or not.
Several months ago, just a few days before the moving van had arrived, Patient S. had popped into her rheumatologist’s office (while her kids were in school) to get a refill on her arthritis medication. Her old rheumatologist, Dr. A., a kindly older man, had just retired and she would be seeing Dr. R. for the first time. Things had been going very well with Dr. A. and the medication was working just fine, so Patient S. was expecting today to be a fairly routine office visit.
After the nurse left the examination room, Dr. R. came in, introduced himself, then opened up Patient S.’s chart and started reading it, apparently for the first time.
Patient S. sat quietly and waited while he turned the pages for what seemed to be an awfully long time. She began feeling agitated as the expression on his face became more and more concerned, and he kept flipping back and forth from one page to another.
Finally, she spoke.
“Um, is something the matter? I just came in to get my prescription renewed, and I have to leave soon because the kids…”
“Have you ever had an x-ray?” Dr. R. demanded.
“Well, no, Dr. A. did an examination but didn’t think that was necessary…”
Dr. R. sighed heavily.
“Blood work? When was the last time you had your blood work done?” he interrupted.
Since she was getting ready to move to another state, Patient S. had a lot on her mind and wasn’t sure she could even remember when the kids’ birthdays were at the moment!
“Um, doesn’t it say in there?” she asked pointing at her chart. “I mean, I don’t remember for sure, but I think that…”
Dr. R. looked annoyed.
“Look,” he said, “it is very important that you have your blood work done every six months minimum, you have to remember that! Also, you will definitely need an x-ray.”
He suddenly got up, left the room and summoned the nurse.
The nurse came in and handed Patient S. the written orders, and gave her directions on where to go in the facility.
Patient S. was feeling anxious and confused at this point. Was there something she should have been worrying about? Hadn’t Dr. A. done his job properly? Why was Dr. R. so concerned all of a sudden?
“When is Dr. R. coming back in?” she asked the nurse. “I need to ask him some more questions, and I don’t have a lot of time left before I have to get the kids.”
“Oh, I’m sorry,” the nurse said, “he’s with another patient now.”
“But what about my prescriptions! I only have two capsules left and we are moving away in three days. I won’t be able to see a new rheumatologist for a while until I get settled.”
The nurse ducked out of the room for a few minutes, then came back and told Patient S., much to her relief, that Dr. R. had gone ahead and authorized the refill, so long as she got the labs and x-rays done.
…
Fast-forward to several months later…
Much to Patient S.’s relief, her new rheumatologist, Dr. S., was a relaxed, friendly woman who was easy to talk to. While Dr. S. looked at the digitized version of Patient S.’s old chart her computer, Patient S. gave her an animated account of her last office visit, and asked her if there was something she should be seriously worried about at this point.
“Hmmm,” Dr. S. said, staring at her computer.
“What does it say?” Patient S. said worriedly. “He didn’t give me any information!!!”
“Well, see for yourself,” Dr. S. said, and smiled sweetly and turned the computer so that Patient S. could look at her chart.
As it turned out, Dr. A.’s old-school hand-written chart was completely unreadable!
What Patient S. had interpreted as Dr. R. being worried and anxious while reviewing her chart, had turned out to simply be frustration over not being able to read it. And why he chose not to share this with her remains a mystery. Her unnecessary emotional suffering could have very easily been avoided in the first place!
And after an examination, lab work (and x-rays, just to be sure) it turned out that there wasn’t anything new to worry about at all…
This situation is an example of failing to apply not just one but several of the Patient Voice Principals:
Patient + Clinician Partnering: Dr. A. did not fully involve Patient S. in her own care
Access to Meaningful Information: Neither Dr. A. nor Dr. R. had given Patient S. access to her own clinical information
Compassionate Human Interactions: Dr. R. did not communicate well with Patient S., thus causing her undue anxiety for no reason.
