Medical

"A responsible parent, I took a quick look in the medicine cabinet to check on the expiration dates of her Albuterol and DuoNeb. Sure enough, both had expired."

I'm sorry, but as a reponsible parent, should you not have refilled the prescriptions before they expired? If it was such a huge concern to you, as it seems to be by the tone of your story, wouldn't you have maybe jotted down the expiry date on a calendar so you knew they were coming up. In my opinion, it sounds like you are trying to blame someone else for not taking responsibility of something that was yours to begin with.

7/14/08 at 5:12 PM

I'm not suggesting not to do a background check. What I'm suggesting is that they are often done badly and with sources that range from useless to suspect. The claims that they help "curb internal fraud" is nothing but an unsubstantiated claim. The one - and only - study looking at using credit reports found no correlation between credit scores and the propensity for committing a crime against the employer.

My point - checks are not something you can outsource to a clerk in a call center. This is something you can - and must - do yourself.

Thank you for writing!
Peter ...

7/1/08 at 3:47 PM

Talk about timing I read your post shortly after mine was published about the over use of pre-employment credit checks, "Would you hire the candidate with bad credit who has been out of work for 11 months?" I had not even touched the issue of wrong information. FCRA actually includes a process for candidates to respond to credit report errors to potential employers. I agree that good solid interviewing and real reference checks are better tools than consumer credit.

6/5/08 at 9:13 AM

The solution to bad background checks is not to stop doing them, it's to find a better provider to do them. Background checks are one very basic, but very important tool that can be used by employers to help curb internal fraud.

6/4/08 at 5:07 PM

Great post Peter, and I agree that low tech solutions like this make sense in practicality. If patients were this organized this would make the lives of physicians easier and the continuity of care much better.

However, the low tech solution still doesn't provide a standard format by which data can be read, understood, and acted upon in the same way that can be addressed by an electronic PHR. Not that I think Google or Microsoft will be a legitimate player in the storage and use of PHR's right away, but they are getting the ball rolling in the right direction at least. The real benefit is going to come when a true standard (or only a couple of agreed upon standards) is agreed upon, and meaningful and accurate information can quickly flow from patient record to physician database in mere seconds.

Tannus Quatre
www.vantageclinicalsolutions.com/blog ...

6/2/08 at 6:00 PM

The truth is that many offices adhere to a template given to them by the software company that doesn't get changed. Consults (first time visits) and follow ups have to be given much different lengths of time. In addition, depending on the difficulty of the case, more time can be given even for a follow up --depending on what needs to be done
Of course, this is the beauty of a smaller practice where even the people at the front desk understand the unique scheduling needs of each patient. Unfortunately, in many practices, one the MD sees the patient the chart is sent along with the MA to the front desk where the receptionist has little inkling of the needs.

The truth. Yes. Patients do omit the truth. I could tell you about the patient who came into the ER with a 4' of garden hose in his intestine. How did it get there? He wouldn't admit. Turns out it was a beer bong, and he didn't want to tell his nondrinking religious family he drank --like a fish. After surgery, a referral was made to a social worker and psychiatrist.

Smoking is something many are loathe to admit, and often we've seen patients with wounds that just weren't healing. Once, I saw a patient smoking in the parking lot. We'd asked her many times before, and told her that smoking can delay the healing process of her type of surgical wound. Lo and behold, when she came up for her 5th recheck ( as opposed to a usual one or two), I asked her if she smoked, and she said no.
I asked again, and she still said no. I asked again, and she admitted to "a little bit." These are what we call difficult patients and usually they've given us issues every step of the way.

In extreme cases, you can relinquish a patient. However, you must follow the exact directions of your malpractice carrier. There is a protocol, and there are specific conditions for doing so as dictated by the malpractice carriers . THis not only takes a degree of firmness, but meticulous record keeping and above all --diplomacy when you do it. And yes, it is always done via a well written registered letter.

5/26/08 at 8:12 PM

I hope that, in addition to advising the docs on "how to make patients great" you can focus on the complaints that the patients have -- very correctly listed -- and tell us all how we can make doctors "great". That may be the more difficult task.

5/21/08 at 4:52 PM

You got Paul Newman right, and the chain gang scene -- but the movie with the line was *Cool Hand Luke*, which ends in that great tragic scene with Luke in the shack, surrounded by policemen... Let's hope a better resolution is in store for the doctor-patient relationship!

5/20/08 at 5:28 PM

This is an area of great concern. When I went to hire new staff, I always tried to get people in the area. Now, two have moved out and face long commutes. One has purchased a new car, another is stuck with the gas hog she purchased prior to the big rise in gas prices --against my advice. The idea of a pass is great, --if you live in an area with reliable and easy mass transit. We don't! So my general advice would be to look in the local pool first. Only if you can't find any qualified individuals, would you extend your radius out ten miles.

5/7/08 at 2:58 PM

When I took over this practice, the old staff was reluctant to take credit cards because of perceived "loss" when it came to the percentage charged. However, I pointed out to them that if they had a chance to collect money up right then and there, or "wait" until the patient paid, they were always better taking money upfront. Let's face it. I'm piloting a business that everyone says should be falling apart. A solo practice is almost unheard of. So we have to be very smart with collections. Today, with more patients falling off the insurance rolls, and other patients being put onto high deductible PPO plans, it's more urgent than ever to have a way to collect money up front. Accepting credit and debit cards is vital. And yes, you do have to look around for the best rates. Also --I've found it best to set a $25.00 minimum. If your average sinks below this, the companies can often push your rate higher. In addition, it's not uncommon for many business to tack on a small surcharge for the convenience of using the machine. Cash is fine, but you do have to count out at the end of each day. Even if it's a small practice. Believe me, that's the first place revenues will disappear. And believe me --I've caught it before, have fired people and made police reports. The ability to collect past due accounts depends greatly on your billing staff. Always make the phone call and work out an amenable payment arrangement. Once it goes to collections, the percentage you pull in is very small --if not lost altogether. As for your bottom three --those are specialties which are reliant on the hospital sending them reports so that they can bill for services rendered. It still doesn't answer why their own billing companies that they hire don't take cc's, and definitely, they'll have to work on changing it.

5/7/08 at 2:53 PM