learning great patient-centred care and then receiving terrible care. grr.

[oldanddone]

So I'm a family doc just out of residency. I've been studying for certifying exams, and I'm also pregnant.

Today I had an experience of being disregarded as a patient in a way that would be failed on any certifying exam. Just a basic thing around preserving a patient's dignity with draping, and listening to a patient when they are refusing to go ahead without a drape rather than just barreling along.

I'm left feeling so frustrated. Do I say something; if so , what is the best protocol? This is an area I may end up setting up practice, and it is rural, so that complicates possible future relationship regarding referral for that specialist.

Anybody else have stories of confronting poor patient-centred care received as a patient? Or having one of these 'critical conversations'? I generally knew to avoid even trying as a trainee. but now as a patient? grrr. Would love some feedback from the family med community, as we do have such an emphasis on patient-centered care, so would recognize when we are not receiving it.

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[alisepeep]

i had a similar experience. This was a male doctor and they had me wear one of those cover up paper vests. He came into the room and didnt even close the door behind him and started talking to me. While i am laying there topless with nothing but that paper vest with the door fully open! hippa violation and very improper patient privacy. Then he left and didnt close the door and i had to get up and walk there with once again that vest, bra less to close the door. This guy was also condenscending. I would never send a patient to this specialist, but he is like 75 i dont know why he is still working.

 

[deleted87716]

If a doctor knows you're in medicine and they treat you like that, they're clueless. Go elsewhere.

They shouldn't treat ANYBODY that way, but if they don't take particular pains to be gracious to colleagues, they're totally out to lunch. Vote with your feet.

 

[Chicago2012]

Before I started medical school a Family Doc in the southern suburbs of Chicago was our PCP. My wife went in with RUQ pain and nausea and his diagnosis was anxiety... Yeah, haven't been back. The sad part is that that particular health system has an FM Residency

 

[oldanddone]

Here's the update. /rant

So that rural/periphery ob doing the u/s said he ruled out vasa previa but didn't comment on 'vessels of unknown significance' in the cervix.
Went to major tertiary centre for u/s, which was read as concerning vessels. This was delayed, since local u/s had been 'clear'.
So at 36 and 6, with possible vessels relating to fetal circulation (although not classic vasa previa) running possibly across the canal i'm soft-transferred to the ob on call in a community that at least has a nicu, on a friday.
no call from ob's office.
saturday, i call the on-call at the hospital i trained at, and got somebody who precepted me and i trust, and was told to get'er done myself- i.e. go into the tertiary centre to triage if i couldn't get high-risk obs oncall on the phone to discuss.

so i did, as i was concerned there were vessels that might relate to fetal circulation, and i was at 36 and 6 (well beyond csxn timing for fetal circulation compromise potentials). was good news in the end, that the vessel was related to maternal circulation (although maternal hr at this point was from a baseline pre-preg of low 60's to mid 120's with all of this), didn't cross the canal. at that point, i was reassured that at least there's a little more time if attempting vaginal delivery and there is excessive bleeding.

yesterday, i finally met the ob i was transferred to in the community with a picu. in a lineup of pregnant women, i'm being asked by the secretary at an open-concept front desk with no privacy what my occupation is, what my partner's occupation is, how many pregnancies i've had in the past, how many miscarriages, and what my period cycles are like. then told to go dip my own urine and come back to show the stick. all that kept going through my head was the recent magazine article that comes from our national physician - operated medical liability insurance organization that reviews recent cases, talking of a complaint regarding an office where confidentiality was broken due to protocols regarding the secretaries repeating names/medical info/etc over the phone for all to hear. i suppose that news hadn't reached this office.

I don't want to put in formal complaints, because i don't agree with how that system works either, but i think i will write an article for one of the journals we have, that has a 'personal essay' place, to chat about recent engagement with the healthcare system. Another recent article there had a doc ending up chastised by the local college (board) for looking at his own charts when he couldn't get an answer from his local doc's office, in a system he had access to - to discover he had cancer that needed prompt attention. ultimately he was chastised for accessing his own chart. this 'circle of care' bull should consistently include a patient! if patient is on system with access to chart, then should not be stone-walled. good lord.

In my case:

1. draping with a hand-towel while being talked to dismissively leading to compromise of dignity and care
2. delay of care
3. transfer of care for possible fetal circulation compromise during early labour - at 36 and 6 weeks, well beyond the 34 week marker for these things to be definitively determined and plans arranged either way.
4. untimely first consult for such an issue
5. forced to reveal personal information at a front-desk with no privacy from waiting room (had to do this at lab-work recently too, to a secretary at a diagnostic lab....wtf?)

The way med is going is bs. Factorization of people. the concept of human relationship and privacy is totally dead in this 'industry'. Ugh. I don't want to need help ever again. Giving me new awareness of how I want to ensure being patient-centred myself.

/rant over