Healthcare quality

[PADan]

I’m supporting my 68 year old brother who has recently been diagnosed with prostate cancer. He lives in Pennsylvania, near Scranton/Wilkes-Barre - A seemingly fairly competent healthcare network - so I thought. This area was/is my hometown. I left many years ago, currently I’m back to care for my end of life Dad who is succumbing to the ravages of dementia.

It’s amazing and scary to me ; a recently retired, highly skilled and educated healthcare professional, the lack of holistically managed care from my brothers care team.

The right hand literally does not know what the left hand is doing. There is no continuity of care. Oncologist has not reviewed my brother’s chart and was unaware of a recent prostate biopsy. The urologist who did not review the chart and was unaware of brothers recent spinal surgery. These are huge lapses.

I find this lack of care unacceptable. How as a healthcare provider could one not review a patients medical history prior to meeting with them ?

Is anyone else seeing this in their healthcare systems ?

I am dad and brothers advocate - I’ve prevented unnecessary surgery, wrongly diagnosed diseases, medication errors and corrected many issues with incorrect medical information.

This is frightening!

Any thoughts my friends.

 

[Closet_Gamer]

DW has been going thru a variety of orthopedic issues and she is quite angry that even within that discipline and practice docs don’t look beyond their immediate specialty.

As she said, her knee, hip and back are literally connected … why does she have to be the one to sort out if her hip issue is actually be driven by her knee?

 

[teejayevans]

I’ve heard good things about Geisinger system.

 

[Koolau]

It would seem that you've run into a particularly poor health care system. So far (in 17 years) the system I use seems much better than this. Having said that, you STILL must look after your own interests, question everything, trust-but-verify everything.

No excuse for what you've seen in the system, but I'm guessing they would say "we're extremely busy and stuff slipped through the cracks."

My PCP who is one of the best I've had makes small mistakes in, for instance, small details in his narrative in my chart. I don't correct them as they're not material. But he's always on top of things - including my other doctors' diagnoses. You have a right to expect good, consistent, competent care.

 

[Midpack]

Fortunately we’ve had pretty good experiences where we live, but medicine is no different than other professions - there are good and bad performers. It’s crucial IME to be your own advocate, or have someone in that role - and it requires diligence. I recently went through prostate cancer and I was not impressed with some of the testing and diagnosis doctors. So when it came to treatment, I did a LOT of research and chose my oncologist carefully. Even though he was 140 miles away, I knew that the variation in success from the best doctors to the worst is astonishing. Obviously they don’t make it easy to find that information but you can get at it if you really try.

 

[Jerry1]

One thing I try to do is keep all my care with the same provider network. I’m spoiled because that provider is the University of Michigan health system. All the doctors seem to know what’s going on and they are well connected using their IT system. They also seem very diligent about entering in the medical information and reading what the other doctors have written. It’s all right there.

What you point out in the original post is scary and reinforces something Midpack mentioned. You have to be your own advocate or have someone to help, as the OP is obviously doing. It really scares me to think about the people who don’t have an advocate or the capacity to be their own. The U.S. health system seems to be a feast or famine environment. There’s obviously some great providers and treatments that boarder on miraculous but, there are a lot of mediocre providers/systems out there that the majority or people have to navigate.

 

[sengsational]

Most of my providers use an "Epic" based system, and I have configured it to allow visibility across all. My GP isn't on an Epic platform, though, so that requires more attention from me.

I have a spreadsheet (of course I do) that is a chronology of every medical intervention and test result that I think might be important, and keep that up to date. I bring a hard copy and that lets me answer "what and when" questions precisely.

I don't think there's any way nowadays other than being your own advocate.

 

[aja8888]

I’m supporting my 68 year old brother who has recently been diagnosed with prostate cancer. He lives in Pennsylvania, near Scranton/Wilkes-Barre - A seemingly fairly competent healthcare network - so I thought. This area was/is my hometown. I left many years ago, currently I’m back to care for my end of life Dad who is succumbing to the ravages of dementia.

It’s amazing and scary to me ; a recently retired, highly skilled and educated healthcare professional, the lack of holistically managed care from my brothers care team.

The right hand literally does not know what the left hand is doing. There is no continuity of care. Oncologist has not reviewed my brother’s chart and was unaware of a recent prostate biopsy. The urologist who did not review the chart and was unaware of brothers recent spinal surgery. These are huge lapses.

I find this lack of care unacceptable. How as a healthcare provider could one not review a patients medical history prior to meeting with them ?

Is anyone else seeing this in their healthcare systems ?

I am dad and brothers advocate - I’ve prevented unnecessary surgery, wrongly diagnosed diseases, medication errors and corrected many issues with incorrect medical information.

This is frightening!

Any thoughts my friends.

Dan, I'm originally from Pittston (you know where that is). I left as quick as I could.

 

[COcheesehead]

Our medical history is kept in a portal for us and our providers to see. I can look back at every contact point, vitals at the time, recommendations etc. So when we see our doctors, we pick up where we left off and there is continuity.
The portal is called Follow My Health

 

[pacergal]

You would think with EMR (electronic medical records), that seamless care would be happening, as that was the touted intent in the design.
Alas, it doesn't seem to work that way.
The PCP is the supposed "gatekeeper" to be the one to coordinate all the specialty care. However, you would think the specialists would all want to know what is going on. In my experience, that is not true. They only deal with "their" issue or what ever you were referred for. Certainly no speculation as to other issues that may be coinciding together.

My son had a traumatic accident 20 years ago and is dealing with the long term effects on his body, especially as he hits his middle age. He currently sees specialty ortho for arm, knee, back and hip issues (all separate and not co ordinated), a physiatrist for rehabilitation, a pain specialist, an acupuncturist, and a few others. He has been referred to one after the other for over a year and is still trying to deal with all of the issues. Each dr says "that's not my specialty".
His PCP works diligently with him, but jeeze! Its frustrating.

 

[Qs Laptop]

I find this lack of care unacceptable. How as a healthcare provider could one not review a patients medical history prior to meeting with them ?

I've seen cardiologists who are reading my medical history as I'm sitting in the room with them. Also urologists have done this same thing. They're so busy they don't have time to review prior to the meeting. This has only occurred with the overworked doctors from my wife's employer's health care network.

Is anyone else seeing this in their healthcare systems ?

Unfortunately, yes. I am seeing this in my health care system that I had with insurance through my wife's employer provided network. I'm still seeing some doctor's in that network and I'm not impressed.

Now that I'm on Medicare (with Medigap) I am picking and choosing new doctors as I see fit. The care I'm getting from these hand-picked doctors has been a lot better.

I am dad and brothers advocate - I’ve prevented unnecessary surgery, wrongly diagnosed diseases, medication errors and corrected many issues with incorrect medical information.

This is frightening!

Any thoughts my friends.

As Midpack mentioned, you really need to be your own advocate. You've got to do your due diligence with providers and doctors. I've needed to take a prosecuting attorney's attitude to my cross examining, questioning of them regarding many things because sometimes they are reluctant to volunteer information.

Also, as COcheesehead says, make use of the patient portal medical records and test results. When I went to my new urologist (using Medicare) I brought along my test results from my previous urologist. He was a bit impressed and also appreciative of that.

 

[Midpack]

As Midpack mentioned, you really need to be your own advocate. You've got to do your due diligence with providers and doctors. I've needed to take a prosecuting attorney's attitude to my cross examining, questioning of them regarding many things because sometimes they are reluctant to volunteer information.

While I recommended being your own advocate, that doesn’t include taking a “prosecuting attorneys attitude” with a doctor in my view. No doctor, good or bad, is likely to respond well to endless questions from a layman who hasn’t done any homework. I detailed how I went about it in another recent thread. But briefly:

• I educated myself as much as possible about my condition and treatment options so I could easily understand what the doctors were telling me and not waste their time with dumb questions. I’m not suggesting all questions are dumb, but a patient should learn as much as they can in advance so they can ask intelligent questions. A good doctor appreciates a knowledgeable non-confrontational patient.
• “Your decision about who will manage your prostate cancer is one of the most critically important decisions you will ever make” was crucial to my research. The probability of success for a serious treatment between the best and worst practioner is huge. Needless to say no doctor will help you figure this out. I learned with lots of reading to find the best sources. And searched for centers of excellence, readily available online. The good news is in today’s Internet age you can find the information. Generations ago it was probably impossible.

 

[Lorenzo]

Our medical history is kept in a portal for us and our providers to see. I can look back at every contact point, vitals at the time, recommendations etc. So when we see our doctors, we pick up where we left off and there is continuity.
The portal is called Follow My Health

Some of my doctors use FollowMyHealth, but others do not. It would be great if there were a single portal that all healthcare providers used to access a patient's data. This is one area where the countries with a national system have us beat.