entitled/"VIP" patients

[dragonfly99]

This thread is about those VIP/entitled patients. I'm just wondering if anyone else gets annoyed by these types. You know, the ones who are admitted and are some rich person, or a friend of the dept. chair, etc. My experience is these are a pain the a** and I groan every time I hear that I'm getting one. I am just wondering if anyone has any good stories...
come one, I know someone is a resident @Mayo (grins)

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[Winged Scapula]

I have one right now - a friend of a friend who is a local physician.

She is expecting me to hold open my entire morning surgical block for her while she decides which surgical option she wants. She is also expecting the plastic surgeon to do the same - hey, fine for him, he's semi-retired and keeps a light schedule but I've got other patients and other cases to do.

As a matter of fact, she didn't even discuss this with me, but called my surgical scheduler herself and put herself on my schedule for a certain date and told the scheduler to block off the entire morning.

Learned Friday that she may want *another* option (which I had only in passing discussed with her) which takes *twice* as long. How did I learn this? She mentioned it to the plastic surgeon's scheduler. No insight into the fact that I may just not have the time to do the second procedure and that I might have other patients, at other hospitals, who are already booked. No discussion of this possibility with me (which would essentially require rescheduling the other patients already on for that day).

It sucks all around, especially because she's a friend of a friend and I would have to tread lightly on this one. I try to tell myself I should feel honored that I was chosen to be her surgeon (since she is close friends with another surgeon in my field and I'm relatively new) but really it feels like a big joke to me.

 

[anon-y-mouse]

This thread is about those VIP/entitled patients. I'm just wondering if anyone else gets annoyed by these types. You know, the ones who are admitted and are some rich person, or a friend of the dept. chair, etc. My experience is these are a pain the a** and I groan every time I hear that I'm getting one. I am just wondering if anyone has any good stories...
come one, I know someone is a resident @Mayo (grins)

I find many people who act "entitled" like this (in my limited experience being a "real" doctor) are doctor-patients. I took care of one recently who expected me to list off every single medication and PRN the primary team had ordered for him in the hospital, make demands for extensive workup of benign complaints, and argue about the modality of his workup. I took a gamble, but decided to firmly stand my ground, set limits and expectations, and used such lines as "I can't order fentanyl for you" with a straight face -- it worked and he backed down. Really intimidating, as he was over twice my age with a lot more experience, but I feel I did the right thing and it worked out in the end.

 

[Stitch]

I think it's more than just rich privileged people, and I think it's becoming more common. Due to overemphasis on the word 'autonomy,' patients are beginning to view medicine like fast food. We have to do it your way, regardless of what the provider feels is appropriate.

I've found that setting boundaries are definitely the way to go with these types of people. You have to say no, politely but firmly. The issue tends to be that someone on the care team gives in to them so you get stuck with it.

 

[Gastrapathy]

deleted.

 

[MR1]

As a matter of fact, she didn't even discuss this with me, but called my surgical scheduler herself and put herself on my schedule for a certain date and told the scheduler to block off the entire morning.

Wow, serious over stepping the line.
Also why would your scheduler do this without talking to you first?
Hate that you have to tread lightly, anyone else and you could just fire them.

 

[Winged Scapula]

Wow, serious over stepping the line.
Also why would your scheduler do this without talking to you first?

Because my scheduler assumed that I had talked to her about it (she knew that this physician and I had talked frequently).

Hate that you have to tread lightly, anyone else and you could just fire them.

Exactly.

 

[turquoiseblue]

Because my scheduler assumed that I had talked to her about it (she knew that this physician and I had talked frequently).
.

WS, I think that you should politely lay down the law with your scheduler so that this can't happen again. I'm sure they'd understand. If you let your scheduler go off on this lightly she may get the wrong picture for other patients. You don't have to tread lightly if lives are on the line no matter who is friends with who.

I think entitled patients think they are entitled to certain things and have the wrong idea of how a hospital is run and how perfect the system can be in their minds, but once you tell them what the reality is, and explain it to them, and make them realize that it is like that at all hospitals no matter where you go, i would bet they would start to understand.

for example, if your patient is some important court judge who has loads of money and knows high end people in the hospital it is understandable how they would have excessive demands, like getting the biggest nicest room with best view in the hospital, because they are high ended people in the public eye, and you do all you can for them to accommodate, but at some point you have to tell them there is only so much you or anyone else can do.

 

[PharmaTope]

did a consult on a guy who was the father in law to the head trauma surgeon. kind of a pain in the ass.

the trauma surgeon was known to be a real a-hole in the hospital but he was nice to me. funny thing is he told me "ya i know my father in law is a real pain in the ass"

 

[dragonfly99]

did a consult on a guy who was the father in law to the head trauma surgeon. kind of a pain in the ass.

the trauma surgeon was known to be a real a-hole in the hospital but he was nice to me. funny thing is he told me "ya i know my father in law is a real pain in the ass"

LOL. Next thing you know the father-in-law will take you aside and confess that his son-in-law is kind of a pain in the a**

 

[Winged Scapula]

WS, I think that you should politely lay down the law with your scheduler so that this can't happen again. I'm sure they'd understand. If you let your scheduler go off on this lightly she may get the wrong picture for other patients. You don't have to tread lightly if lives are on the line no matter who is friends with who.

What makes you think I haven't? And please don't think I would ever risk "lives on the line" simply because of some VIP patient. I am a little more savvy than you appear to think. Thanks for the advice on running my practice but this isn't about me.

 

[peppy]

I think it's more than just rich privileged people, and I think it's becoming more common. Due to overemphasis on the word 'autonomy,' patients are beginning to view medicine like fast food.

Funny that this thread came up the same day I read this article: Punishing Doctors Who Make You Wait

A good reminder of how patients are, in fact, the enemy and that patient contact is not as cool as it sounds to a MS1/MS2.

 

[mdphd2b]

When I was a medical student, I took care of one such patient who called her own consults. She had access to all the pager and pickle phone numbers, and didn't mind going over the primary team's heads to call the consult fellows, even if no consult was ordered

 

[adam6]

I think it is terribly ironic when doctor-patients and/or doctor's family members insist that they do NOT want to talk to med students or housestaff. As for rich/VIP patients, I wish they would realize that the best way to become true "VIPs", is just to be really nice

 

[fab4fan]

It's not just the wealthy people; bad behavior cuts across all groups. The fast-food mentality and "Hey, boy" attitudes really wear me down. I had someone get nasty with me because their chemo ran longer than what they wanted.

 

[FutureInternist]

My hospital is pretty good about NOT catering to their demands, since they expect the same treatment for every patient....kinds nice when the attendings fires the brother of the CEO as a patient since he doesn't want to see med students & pages us to re-discuss every minute point of his treatment.

 

[Winged Scapula]

...kinds nice when the attendings fires the brother of the CEO as a patient since he doesn't want to see med students & pages us to re-discuss every minute point of his treatment.

We had a patient like that on Vascular Surgery when I was a resident. Trouble was, our attending didn't have enough balls to tell the patient that he was at a teaching hospital and had to see medical students and residents.

She made the mistake of agreeing that we didn't have to see him and that she would manage his care. I'm sure she enjoyed those middle of the night pages from him.

 

[glamqueen]

What makes you think I haven't? And please don't think I would ever risk "lives on the line" simply because of some VIP patient. I am a little more savvy than you appear to think. Thanks for the advice on running my practice but this isn't about me.

This for sure made me laugh. Someone not currently in residency and not even done with a residency (in surgery for that matter) telling a veteran attending surgeon how to function in practice...

People can be so bizarre on the Internet....but amusing nonetheless. What is it about an online persona that makes people think they have all the answers?

 

[turquoiseblue]

This for sure made me laugh. Someone not currently in residency and not even done with a residency (in surgery for that matter) telling a veteran attending surgeon how to function in practice...

People can be so bizarre on the Internet....but amusing nonetheless. What is it about an online persona that makes people think they have all the answers?

well when he/she said they treaded lightly...it made it look like nothing was done.....should have gotten mad right away and not let anyone off the hook especially if it was a secretary's misunderstanding....it was just a suggestion, don't see why people have to be rude about it....and it is none of anyone's business what has happened to me in residency...and u don't know if i'll get residency or not...i don't see why' you're a med student and talking to someone that's been in residency (me) the way you do...so same difference.
basically "i learned it from you".

 

[PlutoBoy]

Wow, people need to give Turq a break

 

[dpmd]

I don't change my behavior just because someone is CEO of this or that, or related to so and so. I have been consulted on employees of the hospital, and in that case I would ask them if they minded a student being involved with certain aspects of their care (like the time I had to examine the scrotal abscess of an employee), but I never offered to take the students or myself off the case. When I was a med student and had to have surgery, I didn't declare that the fellow or resident was not allowed to touch me. When a colleague of mine had to have a dx lap by the ob-gyns she just asked that the number of people around before her vag was covered up be minimized. An attending who was in an MVA was fine with the residents and students taking care of him (although he loudly and repeatedly demanded no foley be placed-I blame the concussion). I suppose if the illness or injury is embarrassing (rectal foreign body perhaps), I could see requesting privacy if you work at the place.

 

[adam6]

I don't think that this is always about VIP treatment. i was hospitalized during my internship and politely asked for no students/residents/fellows, Why? Not because I didn't want them to learn but becaus it was a situtation where I didn't want all of my colleagues hearing about it and getting involved or see me at a time when I was not at my finest.

Personally, as a resident, I don't mind when an attending from another department comes for treatment and asks for no residents. I understand that it would be somewhat difficult to maintain the attending resident relationship in cases like this. I give the same benefit of doubt to attendings family members. I guess i've gotten use to it as this is not an uncommon situation for us.

I think this is a totally different situation then what I meant to be describing. I can understand the desire for privacy when it involves people you work with directly. If you are in IM and you are admitted for an IM-related issue at your own hospital ...sure-defer coverage. In fact, I remember being uncomfortable when I had to admit one of the attendings I had worked with (and wished he was non-teaching). But all of the instances I'm recalling had nothing to do with privacy.

 

[intmed3]

I do think there's something to be said for professional courtesy. If another physician (or a physician's family member), is having a medical problem, I would certainly do my best to help them out. However, I don't think it's appropriate to demand a different level of care or special treatment.

 

[turquoiseblue]

I seriously think all patients should be treated like VIP's. That way they'll never demand anything from you. No one deserves any less than VIP treatment

 

[deleted50541]

I'm rotating through our private insurance only, suburban hospital and was expecting a rash of VIP/entitled A-holes, but thankfully they've been the exception, rather than the norm. But man, when they arrive, talk about a time-sink. I just cannot break away from their incessant questioning of our clinical judgement and intentions. And then the nurses are paging me every half hour, saying they're becoming more irritated and frustrated that nothing is happening, when I spent a good 15-20 minutes alone that morning and then with the attending explaining the treatment course and plan for the day.

And then come the threats of leaving AMA or calling everyone under the sun from hospital administration to patient advocacy. By then, remembering my professional duties is the only thing keeping me from blowing a gasket and going off at them.

 

[turquoiseblue]

I'm rotating through our private insurance only, suburban hospital and was expecting a rash of VIP/entitled A-holes, but thankfully they've been the exception, rather than the norm. But man, when they arrive, talk about a time-sink. I just cannot break away from their incessant questioning of our clinical judgement and intentions. And then the nurses are paging me every half hour, saying they're becoming more irritated and frustrated that nothing is happening, when I spent a good 15-20 minutes alone that morning and then with the attending explaining the treatment course and plan for the day.

And then come the threats of leaving AMA or calling everyone under the sun from hospital administration to patient advocacy. By then, remembering my professional duties is the only thing keeping me from blowing a gasket and going off at them.

that is true. it is very annoying when they do that....they always want an attending waiting on them hand and foot.......my question is what are they doing at a teaching hospital if they don't trust residents?? If they leave AMA that is fine with me... that's part of their right as a patient...and not having to deal with them would be the great part about them doing that.

 

[rph3664]

I think it's more than just rich privileged people, and I think it's becoming more common. Due to overemphasis on the word 'autonomy,' patients are beginning to view medicine like fast food. We have to do it your way, regardless of what the provider feels is appropriate.

I've found that setting boundaries are definitely the way to go with these types of people. You have to say no, politely but firmly. The issue tends to be that someone on the care team gives in to them so you get stuck with it.

Ask nurses what they think of Press Gainey, and how much that has impaired nursing care and time management.

 

[VA Hopeful Dr]

We had a patient like that on Vascular Surgery when I was a resident. Trouble was, our attending didn't have enough balls to tell the patient that he was at a teaching hospital and had to see medical students and residents.

She made the mistake of agreeing that we didn't have to see him and that she would manage his care. I'm sure she enjoyed those middle of the night pages from him.

We had a dermatologist that would walk out on patient's the instant they said anything about not wanting students/residents. I found this pretty impressive as these were often cosmetic only cash paying patients.

 

[fab4fan]

ask nurses what they think of press gainey, and how much that has impaired nursing care and time management.

 

[Winged Scapula]

I don't think that this is always about VIP treatment. i was hospitalized during my internship and politely asked for no students/residents/fellows, Why? Not because I didn't want them to learn but becaus it was a situtation where I didn't want all of my colleagues hearing about it and getting involved or see me at a time when I was not at my finest.

Personally, as a resident, I don't mind when an attending from another department comes for treatment and asks for no residents. I understand that it would be somewhat difficult to maintain the attending resident relationship in cases like this. I give the same benefit of doubt to attendings family members. I guess i've gotten use to it as this is not an uncommon situation for us.

I think this is a different situation and a reasonable request. I don't think this is what the OP was referring to.

When I had surgery (at a hospital not my home hospital) and found out that the resident rotating there was from another residency at my hospital, I said no to having her there as well. Too close for comfort and didn't want my busines being her business.

 

[Winged Scapula]

well when he/she said they treaded lightly...it made it look like nothing was done.....

If you'll reread my post, the comment about treading lightly was in reference to the PATIENT not my office staff. Its fairly delicate to be treating another physician, one who is a friend of a friend, and not give in to their requests which you might not let other patients get away with.

should have gotten mad right away and not let anyone off the hook especially if it was a secretary's misunderstanding....

Again with the telling me how to run my practice. Believe me, getting mad does not solve anything. I have a great surgery scheduler (who is not a secretary, BTW)...yelling at her for what was an honest mistake doesn't help me, doesn't help her nor does it help the patient. A calm discussion was more appropriate and that was what happened. I fail to see anywhere where I suggested that anyone was "let off the hook".

it was just a suggestion, don't see why people have to be rude about it....and it is none of anyone's business what has happened to me in residency...and u don't know if i'll get residency or not...i don't see why' you're a med student and talking to someone that's been in residency (me) the way you do...so same difference.
basically "i learned it from you".

TB - this is not about you nor about your ability to get into residency.

You seem to have hierarchy issues - the med student, regardless of whether they are below you in education, seems to have much more insight into the situation as I described it and that it might not have been appropriate for you to question my practice management. Not because I'm ahead of you in training necessarily but because its my practice and I run it the way I see fit. Don't be that person that refuses to listen to someone else because you seem to think they are beneath you..its childish and arrogant.

 

[turquoiseblue]

can we just drop this. it is such a moot point. i have no heirarchy issues at all...
u should say that to the med student for posting her comment about me not respecing you, like it's a rank thing...she said it, not me. i dont have to accept her rude behavior nor yours no matter who you are, no matter what rank you are. and you don't accept my 'practice management advice'...although i may have insight, similar to me not accepting that rude med student's rude behavior. touche.

 

[Rendar5]

can we just drop this. it is such a moot point. i have no heirarchy issues at all...
u should say that to the med student for posting her comment about me not respecing you, like it's a rank thing...she said it, not me. i dont have to accept her rude behavior nor yours no matter who you are, no matter what rank you are. and you don't accept my 'practice management advice'...although i may have insight, similar to me not accepting that rude med student's rude behavior. touche.

asking someone to drop an issue works much better when not followed up with a continuation of the issue.

 

[PlutoBoy]

Go on

 

[smq123]

We have an attending who has been around forever - is something of an institution. I was having trouble with a patient's wife who was being very bossy and insistent and pushy, and finally said "I want to talk to your supervisor."

The attending came in, and the first words out of the wife's mouth were "DO YOU HAVE ANY IDEA WHO I AM?"

The attending looks at her and goes, "Uh, no. Who *ARE* you?"

She tells him (she's some higher-up in the hospital administration). He shrugs and says, "That's nice," and then walks out of the room.

 

[PharmaTope]

We have an attending who has been around forever - is something of an institution. I was having trouble with a patient's wife who was being very bossy and insistent and pushy, and finally said "I want to talk to your supervisor."

The attending came in, and the first words out of the wife's mouth were "DO YOU HAVE ANY IDEA WHO I AM?"

The attending looks at her and goes, "Uh, no. Who *ARE* you?"

She tells him (she's some higher-up in the hospital administration). He shrugs and says, "That's nice," and then walks out of the room.

hahahahah that is beautiful! real reality check for that administrator. i love it.

 

[Ronin2258]

We have an attending who has been around forever - is something of an institution. I was having trouble with a patient's wife who was being very bossy and insistent and pushy, and finally said "I want to talk to your supervisor."

The attending came in, and the first words out of the wife's mouth were "DO YOU HAVE ANY IDEA WHO I AM?"

The attending looks at her and goes, "Uh, no. Who *ARE* you?"

She tells him (she's some higher-up in the hospital administration). He shrugs and says, "That's nice," and then walks out of the room.

And this is why I love my attendings who have been around forever.

 

[anon-y-mouse]

can we just drop this. it is such a moot point. i have no heirarchy issues at all...
u should say that to the med student for posting her comment about me not respecing you, like it's a rank thing...she said it, not me. i dont have to accept her rude behavior nor yours no matter who you are, no matter what rank you are. and you don't accept my 'practice management advice'...although i may have insight, similar to me not accepting that rude med student's rude behavior. touche.

You have no insight, as evidenced by all the contradictions in the above rambling statement. You have hierarchy issues because you dismiss people's criticisms of any of your statements by virtue of their "lower" position in training, and in WS's case, her "rudeness": speaking of which, she was not rude at all to tell you not to comment on the way she manages her own practice. There was not an iota of rudeness in her statements towards you. People who disagree with you are not "rude", they simply disagree, and your inability to take criticism, as evidenced here, clearly illustrates to me why you are jobless and unable to successfully complete even a year of post-graduate medical education after multiple repeated attempts.

Back on the subject, speaking of "entitled" patients, one of my patients, an 80+ man, has a serious illness with a very poor prognosis. However, he is a curmudgeon who keeps fighting -- both his illness and with any doctor except his outside specialist (and any nurse that tries to do anything toward him!). However, after a few days, I won over his trust by dutifully keeping him in the loop (he kept track of his own chemistries!), spelling things out honestly for him, and checking in on him after consultants met and made drastic recommendations on him. Today, after all that extra work, he offered me free a meal at one of his ultra-luxe gourmet restaurants since I had been dutifully taking care of him. Not sure if I can take him up on his offer (any advice about this?), but it sure felt great!

 

[Ronin2258]

Back on the subject, speaking of "entitled" patients, one of my patients, an 80+ man, has a serious illness with a very poor prognosis. However, he is a curmudgeon who keeps fighting -- both his illness and with any doctor except his outside specialist (and any nurse that tries to do anything toward him!). However, after a few days, I won over his trust by dutifully keeping him in the loop (he kept track of his own chemistries!), spelling things out honestly for him, and checking in on him after consultants met and made drastic recommendations on him. Today, after all that extra work, he offered me free a meal at one of his ultra-luxe gourmet restaurants since I had been dutifully taking care of him. Not sure if I can take him up on his offer (any advice about this?), but it sure felt great!

Gut reaction (no pun intended,) but I can't see that beyond a patient gift. Take him up on the offer..

See, I am one of these crazy people that like these curmudgeons. A lot of them I have worked with have been old war vets that could share a story or two about our time in uniform, and I could glean a good war story out of them. One of them was a radiator designer/fabricator, and, being somewhat of a rotor-head (RX-7 equivalent of a motorhead,) we got into discussing the finer aspects of what is the best material to do heat exchange, and thickness of the coils, especially in the size constraint of a sports car. Broke through to him clinically through that when no other resident could. Got a lot of data out of him to help him out.

Sounds like your man has all his wits about him, if he is being that pro-active. It helps to be nice, as I have stated in one of my posts here, but firm with them. Their world is out of their control, they don't see us for hours on end, or in your case, his days are numbered with a poor prognosis. Guys that age, military or not, want to go down fighting every step of the way. Sounds like you broke through to him and got a rapport going with just being attentive.

If you are a bit of a foodie, and if time permits during the day, talk to him about the finer aspects of his restaurants and some preparation, or why he chooses x-brand over y-brand. If not, read up a bit of the style of food in his places, just to strike up a casual conversation. He may have been a hands-on guy, and did some of it himself. If he makes it out of the hospital, and has to come back, he may request you just because you have some common ground.

And I was laughed at for having a little bit of knowledge in a lot of things, from blue collar work to philosophy. Helps to be well read.

 

[SouthernSurgeon]

can we just drop this. it is such a moot point. i have no heirarchy issues at all...
u should say that to the med student for posting her comment about me not respecing you, like it's a rank thing...she said it, not me. i dont have to accept her rude behavior nor yours no matter who you are, no matter what rank you are. and you don't accept my 'practice management advice'...although i may have insight, similar to me not accepting that rude med student's rude behavior. touche.

Right...no hierarchy issues at all...

http://forums.studentdoctor.net/showpost.php?p=9954395&postcount=83

A tip: by the way do you understand that im senior to you by 2 years, (gonna get licensed) and ur supposed to be bowing down to me instead? and im supposed to smack u up side your head if you don't talk nicely, at least for the next 2 years until you become senior to me. if you don't understand that, ur gonna be a-strugglin' away in residency big time if u talk that way to your seniors.

 

[turquoiseblue]

Right...no hierarchy issues at all...

http://forums.studentdoctor.net/showpost.php?p=9954395&postcount=83

you guys are so out of context..over a stupid useless point...i meant that others will do that in residency, but i don't do that. obviously you don't know me. and i dont see why you want to bother me and do this kind of trash.

 

[Winged Scapula]

Can we get back on topic please?

 

[notinkansas]

Patients like this are the main thing that is driving me out of medicine. And it's not just upper income patients- in fact I find that the entitlement mentality is more prevalent in the lower income group. They come in with a truly demanding attitude, and often can't be reasoned with. Reality TV is making it seem more acceptable to an increasing portion of the population to behave in a demanding and obnoxious manner.

The lay press isn't helping at all. With an increasing volume of articles like "Five tests that could save your life that your doctor isn't telling you about" and the previously posted "punishing a doctor who makes you wait".


I recently had a conversation with a friend after she went to the optician to for new glasses. The practice had recently been sold to a new OD. She didn't need an exam, just needed her glasses fixed, and had to go back a couple times for adjustment. So she hadn't seen the new doctor yet. She said to me, "I think I"m going to switch eye doctors" I asked why, and she said, very indignantly, "The new doctor sitting at a desk in the same area where I was getting my glasses adjusted and she didn't come up to me and say hi and introduce herself" I thought WTF?? My friend's contention was that since this doctor had just bought the practice she should be saying hi and introducing herself to everybody who came in, even if the purpose for coming in wasn't for an eye exam, but just to get adjustments and the like done. She compared it to walking into a retail store and expecting the staff to come up and say hi.

 

[McGillGrad]

Patients like this are the main thing that is driving me out of medicine. And it's not just upper income patients- in fact I find that the entitlement mentality is more prevalent in the lower income group. They come in with a truly demanding attitude, and often can't be reasoned with. Reality TV is making it seem more acceptable to an increasing portion of the population to behave in a demanding and obnoxious manner.

The lay press isn't helping at all. With an increasing volume of articles like "Five tests that could save your life that your doctor isn't telling you about" and the previously posted "punishing a doctor who makes you wait".


I recently had a conversation with a friend after she went to the optician to for new glasses. The practice had recently been sold to a new OD. She didn't need an exam, just needed her glasses fixed, and had to go back a couple times for adjustment. So she hadn't seen the new doctor yet. She said to me, "I think I"m going to switch eye doctors" I asked why, and she said, very indignantly, "The new doctor sitting at a desk in the same area where I was getting my glasses adjusted and she didn't come up to me and say hi and introduce herself" I thought WTF?? My friend's contention was that since this doctor had just bought the practice she should be saying hi and introducing herself to everybody who came in, even if the purpose for coming in wasn't for an eye exam, but just to get adjustments and the like done. She compared it to walking into a retail store and expecting the staff to come up and say hi.

 

[Stitch]

Patients like this are the main thing that is driving me out of medicine. And it's not just upper income patients- in fact I find that the entitlement mentality is more prevalent in the lower income group. They come in with a truly demanding attitude, and often can't be reasoned with. Reality TV is making it seem more acceptable to an increasing portion of the population to behave in a demanding and obnoxious manner.

The lay press isn't helping at all. With an increasing volume of articles like "Five tests that could save your life that your doctor isn't telling you about" and the previously posted "punishing a doctor who makes you wait".


I recently had a conversation with a friend after she went to the optician to for new glasses. The practice had recently been sold to a new OD. She didn't need an exam, just needed her glasses fixed, and had to go back a couple times for adjustment. So she hadn't seen the new doctor yet. She said to me, "I think I"m going to switch eye doctors" I asked why, and she said, very indignantly, "The new doctor sitting at a desk in the same area where I was getting my glasses adjusted and she didn't come up to me and say hi and introduce herself" I thought WTF?? My friend's contention was that since this doctor had just bought the practice she should be saying hi and introducing herself to everybody who came in, even if the purpose for coming in wasn't for an eye exam, but just to get adjustments and the like done. She compared it to walking into a retail store and expecting the staff to come up and say hi.

Not surprising. Remember that 'customer service' and 'satisfaction' are right up there with 'autonomy.' These words currently own medicine and physicians. If you work in the hospital the MBA CEOs will be all over you about it. If you're in private practice, your patients will expect it and your office manager will push for it. No field is safe. And of course it's the only thing that will decrease the liklihood of a law suit (notice practicing good medicine at the standard of care doesn't seem to decrease that liklihood).

 

[notinkansas]

I wish I had realized this before I started medical school.

Today I learned the following from one of the nurses at the hospital where I do a moonlighting type job:

In past couple years, administration here has started requiring that nurses round on their patients hourly. This nurse said they were recently told in a training session that they are supposed to say at start of shift to each patient "My name is X, I'll be your nurse. I'll be checking on you every hour in order to provide you with very good care" Evidently they were told that they must use the language "very good care" several times with each patient. Why? because patients are more likely to report that they had "very good care" on their patient satisfaction survey after discharge if they have heard that term several times during their stay.

I have a very hard time playing games like that.

 

[fab4fan]

Ah, yes. "Scripting."

 

[dragonfly99]

The sad thing is that most patients don't know when they are getting "very good care" medically speaking (or nursing-wise). They do know if we are being nice to them, but most of them don't know whether or not we know what we are doing. They don't know if they are getting medically optimal care. Nurses have it even worse than us, in some ways...they have maybe even more dip**** paperwork that they have to fill out. They spend more time "charting" bs crap in the computer than actually making the patient comfortable or giving out meds, etc. I wish someone would just stop the madness. Bringing this fast food/service industry mentality into medicine I think has done more harm than good...or at least it has gone way too far.

 

[smq123]

In past couple years, administration here has started requiring that nurses round on their patients hourly.

Does hourly rounding really help Press Ganey scores? One of the residents in my program was a patient in our hospital - she said that the hourly rounding drove her crazy. All she wanted to do was sleep!

Our hospital did this thing for a week or two where it would play a snippet of music every hour, to remind the nurses to round. After 8 PM, they would stretch it out to every two hours.

The nurses (and doctors) complained about this, and it was eventually stopped - because the music at night? It kept all the patients awake and decreased patient satisfaction, AND it made all the old people sun-down. The nurses and doctors couldn't get any work done because they were trying to calm down all the elderly demented patients.

Smart idea, nursing administration. Keep on with the bright ideas! </sarcasm>

 

[eforest]

I've found that the most ungrateful, demanding patients tend to be on Medicaid. It's not that it's every medicaid patient is demanding and ungrateful, it's that if a patient IS demanding and ungrateful they are on Medicaid or have no insurance. The VIP patients who came to my med school teaching hospital usually didn't see med students for privacy reasons. Sure, some of the wealthy VIP patients are *******s- but the person yelling, screaming, refusing to see a medical student, demanding to speak to the supervisor, throwing in something about a lawsuit- they tend not to be wealthy VIP patients.