While watching a boring hockey game last night I read this unfortunate story. If you want you can follow the links to try and make sense what happened. What I figured out was that something along the following lines went down.
She was looking after a patient who was booked for a liver transplant workup. The patient was worried about the surgery and asked her what were the options. To the best of her ability and keeping within what she thought were her hospital's policy and her professional guidelines she went through the options which included no surgery and hospice care (this was apparently a terminal condition). The result was that the patient changed her mind about the surgery and elected comfort care only. The doctor predictably had a temper tantrum, the nurse was fired and is essentially now unemployable and on welfare. I discussed this with my wife this morning. My wife a nurse thought that maybe she should have called the doctor or his resident assuming this was a teaching hospital. That might have been a good idea in a perfect world but having worked as a physician since 1983, I know what was probably going on. The patient had probably been referred by her primary care doctor, internist or oncologist and the surgeon had probably booked her based on her CT or MRI without seeing her. If you call the resident, he is unlikely to know anything about the case and will be of no help. The attending will yell at her over the phone assuming she can even track him down. A couple of times a year, I run into a patient in the pre-assessment clinic or quite often in patient receiving who has absolutely no idea or what is about to be done to him. Quite often as physician, I have to believe that what is about to go down is nowhere close to being in the patient's best interest. I have on occasion canceled the case when it is clear that the patient has some doubts about the procedure. Sometimes the surgeon is pissed off and the rest of day is unpleasant, sometimes they are relieved. Anyway as the uber-cynical nurse in Crass Pollination points out she should have not gone where she went and she certainly shouldn't gone public with her plight as she has completely poisoned her career.
This brought to mind something that has been in the news in our neck of the woods and of a meeting I recently attended.
As I blogged a while ago some physicians in our province have alleged that they or colleagues were punished when they advocated for patients. Not some were as lucky as my friend in the blog who apparently got a nice golden apology. Doctors are our own worst enemies and some of the intimidation unfortunately came at the hands of other doctors.
This came out in a rather complicated fashion during the recent intramural campaign to chose a new Premier whereby the eventual winner had promised there would be an inquiry into this intimidation. She no doubt was hoping her promise would be forgotten by the time she won but it was not and so a sort-of inquiry was called and it reported last week. The result was that depending on how you read the report and what political party you support, doctors may or may not have been intimidated.
The week before, I had what started as a friendly meeting with the Site Medical Director (or whatever he is called this week) at our hospital. It was as I said friendly and we went over a number of issues. One of these was the new advocacy line established by the Health Authority. This allows doctors who have issues with administration or other doctors to phone a number rather than going to the press. The problem is that rather than having an independent person receiving the complaint, the complaint goes to the Health Authority. This sounds like a waste of time but doctors will be contacted after their complaint to fill out an evaluation on how they felt their complaint was handled which will be reviewed by....the Health Authority. I had to suppress the tendency of my eyes to roll back in my head.
We talked about a few other issues and then just as I was getting up to go back to work, the SMD asked me, "Why did you write that letter?"
Historical background. Over a year ago one of my anaesthesiologists got into a dispute with one of the RTs. Voices were raised and a letter of complaint went out against my staff member. I investigated, decided that he had been right and the RT was wrong, and I wrote a letter (not that letter) explaining my position. I did tell my colleague that maybe he should keep his voice down next time. Further I initiated a series of meetings with the RT department to make sure that problems and disputes like this never happened again. Case closed.
About 6 weeks, I got an email asking me how I planned to deal with this incident. I replied that I had investigated it and I considered the case closed.
Three weeks ago I got a copy of a letter written by the Zone Medical Director to my colleague. It was a letter of reprimand for this incident. There were no consequences attached to this, so I could have let it go. I was a little pissed off that the ZMD hadn't taken the time to speak with me about this. I felt as Site Leader, I had a responsibility to support my colleague as this was something that would be going on his permanent file. Therefore I felt that the best course of action was to write another letter that would also go on his permanent file. Which I did.
I repeated what I had already written. That I had investigated the complaint; I had found no fault and that the complaint was more due to a long-standing dispute with the RTs which I had since resolved. I closed the letter by stating that if I had to write a letter every time one of my members was treated disrespectfully, I would have a full time job just writing letters.
"The ZMD, " said the SMD ,"is very insulted by this. He feels you are bullying him and he considered calling the advocacy line." "Say what?," I said. ( I guess it was only a matter of time before admin would begin to start accusing anybody who stands up to them of bullying) "Don't you know," when on the SMD,"that this will go on his(the anaesthesiologist's) permanent file?". "That was my intention," I replied. The meeting ended on a somewhat frosty note.
Turning to advocacy.
Doctors are never really completely altruistic when they advocate on behalf of their patients; we all get paid to care for patients, the more care we can provide, the more we get paid. Advocacy is a two edged sword. The squeaky wheel is as likely to get replaced as it is to get grease. Some physicians have been very successful "advocating" for "their" patients, Cardiac Surgeons, Ortho surgeons and Ophthalmologists to name a few. Others, not so successful. Quite a few had their advocacy blow back in their face as we are now finding out (and have known for a long time).
Hospitals of course hate having doctors going rogue on the advocacy field which is while most hospitals including the one I work at have a gag order. If I want to comment on anything publicly I have to go through the hospital's public relations department. One could argue and I would argue if I had been offered the chance to, that any professional has an obligation to advocate on behalf of his patients or patient population within the limits of professionalism. The problem is that by denying doctors and other health care professionals the right to advocate in public, advocacy has been driven underground; far more damaging to both sides.
Sunday, 26 February, 2012
Sunday, 12 February, 2012
How men in groups are idiots
This past weekend I skied Kicking Horse in Golden BC. Because skiing with my adult children would kill me, assuming that they would actually let me ski with them, I most skied by myself. Due to weather conditions that meant multiple runs from the top to the bottom and taking the 8 person gondola to the top.
First trip of the day around 0930, I tag along with a group of 7 men my age. Early in the morning, the reek of stale booze is nauseating. As I look straight ahead trying not to throw up, I am forced to listen to tales of unrestrained male bonding.
Later in the day, I pile in with 7 20 somethings. The fellow directly in front of me has a green colouration and I hear someone say, "I finally don't feel like I have to throw up". They are on a ski weekend stag. They ask me if I am from Golden because they are looking for a stripper bar. Having watched both Hangover movies, I realize that I am now part of a bachelor party and begin to get worried.
Close your eyes though and you couldn't tell the groups apart. Or maybe I am just jealous.
First trip of the day around 0930, I tag along with a group of 7 men my age. Early in the morning, the reek of stale booze is nauseating. As I look straight ahead trying not to throw up, I am forced to listen to tales of unrestrained male bonding.
Later in the day, I pile in with 7 20 somethings. The fellow directly in front of me has a green colouration and I hear someone say, "I finally don't feel like I have to throw up". They are on a ski weekend stag. They ask me if I am from Golden because they are looking for a stripper bar. Having watched both Hangover movies, I realize that I am now part of a bachelor party and begin to get worried.
Close your eyes though and you couldn't tell the groups apart. Or maybe I am just jealous.
Sunday, 5 February, 2012
My private Dell Hell
Have you ever been involved in a relationship that was initially great but has declined with time and now the other's bad behaviour is leading you to want to leave the relationship.
Actually I haven't either but I do read enough novels and watch enough chick-flics to know something about this.
As the title goes this is between me and Dell Computers. (And please Apple users I do not want to hear how I should have bought a Mac)
I bought my first desk top in 1993. 1 megabyte hard drive, 128 kb of RAM, DOS operating sytems. Computers became obsolete within a year then so I bought about one every year. (A major feature of the post-Christmas season was buying a new computer to be able to run the computer games my kids got for Christmas). I always bought from local companies. The computers crashed frequently, the service was horrible. The final straw was when I bought an "in home" warantee for my new computer. When the computer inevitably crashed, I phoned and was told, "Oh the guy who sold you that doesn't work for us anymore and we are not going to honour it." The was about the time Dell started running full page ads on the back page of the newspaper. Therefore we took the plunge called the 1-800 number and 5 days later my wife called me at work to tell me that our new computer had been delivered. New computer day was always a feared day for me, spending hours in uncomfortable positions,having to deal with multiple cables and connections, in between phone calls to customer service; however when I came home my wife had set up the computer and got it running by herself taking advantage of Dell's colour coded cables and easy set up.
Since then I have bought multiple desktops from Dell. They actually last several years. I have also bought 3 laptops (I am typing this on one of them) and I sent my kids off to school with 2 more Dell laptops. Their service has been exemplary, I have had to order new batteries and cables; easily done on their website.
Now a few years ago, I bought a second lap-top, an Inspiron Mini. I paid extra to have it purple. I have taken this little computer all over the world. I loved it as much as one can love an inanimate object. Last fall, the battery stopped taking a charge. No problem I had had it for 2 years and had used it a lot much of the time on the battery. I went onto Dell's website and bought a new battery. A week or so later I had to drive out to the courier depot to pick up the package. When I got home, the battery wasn't even close to fitting into my little computer.
I should at this point introduce a little aside to this whole story. A few years ago Dell opened a call centre in the town where I live. This was open with the usual fanfare and they of course got the usual tax holiday that big corporations get in return for bringing in low paid unskilled jobs to a town. That was where I would have called except that Dell decamped about two years ago; as I was to find out, to India.
Getting back to my story, I called the toll free number, and after some time on hold and after being shunted around a bit, I spoke to someone who assured me that he would personally see that I got the correct battery.
When I did get the battery a week or so later, it too did not fit my computer. Now this computer is a computer that was heavily promoted a few years ago both with full page ads and daily emails to my account. Back to the 1-800 number. The first number I called informed me that I would need to call another number that could only be called during business hours in the Central Time Zone (funny since someone in India was answering the phone). Therefore the next day I called the different number they gave me.
This lead to a hellish 90 minutes on the phone during which I was directed all over the place by a number of polite but unhelpful people with a variety of Indian accents. In between I was tortured by having to listen to Kenny G. I finally actually got to talk to somebody who informed me that he could get me a re-built battery or if I wanted to wait a little longer, a new battery. I told him that I would happily wait for a new battery. That was almost a month ago and I have never heard back from them. Next time I have 90 minutes free I will call them.
I did still have two batteries to send back to get refunds. This required another phone call to explain my problem to polite but unhelpful people with a variety of Indian accents and more Kenny G. Eventually they were able to email me a mailing label (to a Canadian address). I drove out to the courier place where they now know me quite well and sent the batteries back. They weren't finished with me. Periodically during the next week while I was in Ecuador, I would get a phone call from somebody with an Indian accent explaining that they had received my battery or that the refund would soon be processed. Because there were 2 batteries, I got 4 calls.
I now still have my Inspiron Mini which does not work unless I plug it in and frankly I am scared to phone Dell again.
In contrast just before Xmas I ordered a DVD from Amazon and they sent me two by mistake. I was able to go onto their website, "explain" that they had sent it by mistake and they emailed me a pre paid mailing label right away and I was actually able to drop the package in the mailbox.
In time this laptop will start to be unreliable and I will be looking for a new computer. And it probably will not be a Dell. Maybe it will be a Mac.
Actually I haven't either but I do read enough novels and watch enough chick-flics to know something about this.
As the title goes this is between me and Dell Computers. (And please Apple users I do not want to hear how I should have bought a Mac)
I bought my first desk top in 1993. 1 megabyte hard drive, 128 kb of RAM, DOS operating sytems. Computers became obsolete within a year then so I bought about one every year. (A major feature of the post-Christmas season was buying a new computer to be able to run the computer games my kids got for Christmas). I always bought from local companies. The computers crashed frequently, the service was horrible. The final straw was when I bought an "in home" warantee for my new computer. When the computer inevitably crashed, I phoned and was told, "Oh the guy who sold you that doesn't work for us anymore and we are not going to honour it." The was about the time Dell started running full page ads on the back page of the newspaper. Therefore we took the plunge called the 1-800 number and 5 days later my wife called me at work to tell me that our new computer had been delivered. New computer day was always a feared day for me, spending hours in uncomfortable positions,having to deal with multiple cables and connections, in between phone calls to customer service; however when I came home my wife had set up the computer and got it running by herself taking advantage of Dell's colour coded cables and easy set up.
Since then I have bought multiple desktops from Dell. They actually last several years. I have also bought 3 laptops (I am typing this on one of them) and I sent my kids off to school with 2 more Dell laptops. Their service has been exemplary, I have had to order new batteries and cables; easily done on their website.
Now a few years ago, I bought a second lap-top, an Inspiron Mini. I paid extra to have it purple. I have taken this little computer all over the world. I loved it as much as one can love an inanimate object. Last fall, the battery stopped taking a charge. No problem I had had it for 2 years and had used it a lot much of the time on the battery. I went onto Dell's website and bought a new battery. A week or so later I had to drive out to the courier depot to pick up the package. When I got home, the battery wasn't even close to fitting into my little computer.
I should at this point introduce a little aside to this whole story. A few years ago Dell opened a call centre in the town where I live. This was open with the usual fanfare and they of course got the usual tax holiday that big corporations get in return for bringing in low paid unskilled jobs to a town. That was where I would have called except that Dell decamped about two years ago; as I was to find out, to India.
Getting back to my story, I called the toll free number, and after some time on hold and after being shunted around a bit, I spoke to someone who assured me that he would personally see that I got the correct battery.
When I did get the battery a week or so later, it too did not fit my computer. Now this computer is a computer that was heavily promoted a few years ago both with full page ads and daily emails to my account. Back to the 1-800 number. The first number I called informed me that I would need to call another number that could only be called during business hours in the Central Time Zone (funny since someone in India was answering the phone). Therefore the next day I called the different number they gave me.
This lead to a hellish 90 minutes on the phone during which I was directed all over the place by a number of polite but unhelpful people with a variety of Indian accents. In between I was tortured by having to listen to Kenny G. I finally actually got to talk to somebody who informed me that he could get me a re-built battery or if I wanted to wait a little longer, a new battery. I told him that I would happily wait for a new battery. That was almost a month ago and I have never heard back from them. Next time I have 90 minutes free I will call them.
I did still have two batteries to send back to get refunds. This required another phone call to explain my problem to polite but unhelpful people with a variety of Indian accents and more Kenny G. Eventually they were able to email me a mailing label (to a Canadian address). I drove out to the courier place where they now know me quite well and sent the batteries back. They weren't finished with me. Periodically during the next week while I was in Ecuador, I would get a phone call from somebody with an Indian accent explaining that they had received my battery or that the refund would soon be processed. Because there were 2 batteries, I got 4 calls.
I now still have my Inspiron Mini which does not work unless I plug it in and frankly I am scared to phone Dell again.
In contrast just before Xmas I ordered a DVD from Amazon and they sent me two by mistake. I was able to go onto their website, "explain" that they had sent it by mistake and they emailed me a pre paid mailing label right away and I was actually able to drop the package in the mailbox.
In time this laptop will start to be unreliable and I will be looking for a new computer. And it probably will not be a Dell. Maybe it will be a Mac.
Saturday, 4 February, 2012
Why I haven't posted lately
No reason in particular.
I got caught in the Christmas spirit and I really didn't feel like spewing the negative sarcastic stuff I usually write. I did have a nice Christmas thank you.
In January I went to Ecuador for two weeks. This was a medical mission followed by a week of vacation. This is the sixth visit for me. I have some good stories from there that I will eventually tell.
I got caught in the Christmas spirit and I really didn't feel like spewing the negative sarcastic stuff I usually write. I did have a nice Christmas thank you.
In January I went to Ecuador for two weeks. This was a medical mission followed by a week of vacation. This is the sixth visit for me. I have some good stories from there that I will eventually tell.
Tuesday, 13 December, 2011
Coaching in Medicine
http://blog.openmedicine.ca/node/323
This is an interesting idea for CME or CPD or whatever they call it nowadays. Why not spring training every year for everybody. Go over some new things in medicine, practise up on skills that are rusty.
The idea of coaching is interesting too. When a player is having trouble at the plate, he asks a coach (an ex-player) for help or the coach approaches him. Why don't we have a similar model in medicine?
Eventually some academic will have this idea which he will promote as if it is a new concept even though baseball has been doing it for a century now.
Sunday, 11 December, 2011
Some rob you with the six gun, some rob you with the electronic statement
I hate to use this blog to vent my personal problems. No actually that's why I have a blog.
Many years ago after using pay as you go plans, I decided to get a dedicated cell phone with a number and all the gadgets. At that time there were 3 cell phone providers in Canada. As it was more or less six of one and half a dozen of the other (actually 3 of 1 and a quarter dozen..) I ended up with Bell. Up until now Bell has not been bad to me, they have not been particularly good to me either. Periodically Bell calls me and tells me that my contract has been extended. They never ask me if I want it extended and I never argue.
I also signed up for e billing. I hate filing phone statements and as they were automatically debiting my card and am going to lose any fight over the statement anyway (as I found out) so why use it. I had to chose a user name. The usual user names, my first initial and last name or vice versa weren't available so I chose another user name which I of course forgot.
About a year and a half ago I got an i phone. As I was still under contract with Bell, I picked it up at the Bell kiosk in the mall and got a new data plan which enabled me to surf the Internet with my phone. Of course they tell you that you get X number of free bytes of downloads but neither I nor the salesman actually know what that amounts to in the real world. I of course knew that the monthly cost they quoted was nowhere near what I was going to have to pay. When a cell phone company tells you your service is going to cost $X, it is about the same as the surgeon telling you he is only going to take an hour.
By September of 2010 I was so attached to my i phone that when I went to Europe I wanted to be able to use it. I phoned Bell on the #611 number explained that I was going to Europe and wanted to be able to use my phone and download data and the nice lady at the call centre sold me a package. Because my visit overlapped my billing period she said I would have to pay for two months which is a bit of a rip off but hey Bell are not the only people who do things like that. Off I went to Europe where I was able to use Google maps, phone home, receive texts and even almost got a call from the one patient who has managed to get my cell number (I recognized the number and didn't answer). When I went to Africa in June, I spent a couple of days in Belgium and just to check I tried to use my i Phone and got no service.
I continued to see these bills for Bell on my credit card statement and they were a little high but not excessively high so I just figured I must be downloading too much. I kept saying that I should really look at my statement but I had forgotten which of the alternate user names I used and the only way to find out was to log on to Bell's site which of course required my user name. I suppose I could have just called #611 but I really didn't feel like spending time on hold when I have more important things to do like blog, go on Facebook and watch Big Bang Theory re-runs.
Just last week, I tried to log on again and much to my surprise Bell had upgraded their website so that it was actually possible to find out what my user name and password were. I still didn't get around to checking until today. That was when I found out that I had been charged $60 a month for the past 14 months for service in Europe that I wasn't using (I promptly cancelled it on line). I promptly phoned #611 and after a surprisingly short wait (at 0900 on Sunday morning) I talked to a customer service rep who informed me that she could refund the past three months but that was all. She pointed out that I should have checked my statements, I pointed out that I had not asked for more than 2 months service and that if I had planned to relocate to Europe, I would have bought a cell phone there for considerably less than what it costs in Canada. I of course got nowhere. I told her that while I was under contract until 2012 or 2013, I would definitely not forget this and I would be using a different cell company assuming they haven't all amalgamated by then. She seemed unconcerned. Obviously not a shareholder.
So okay, I should have checked my statements. I might even have picked up on it earlier. But that logic is like saying, it was okay for me to burglarize your house because you didn't lock the door. Or say Bell through some glitch forgot to bill me for the past three months, do you think I would have gotten away with saying, "Sorry you should have checked your statements?"
I can of course afford this. My cell phone is paid for by my PC and so it is tax deductible. $700 isn't that much in the scheme of things. But $700 here , $700 there and you're talking real money.
Bell Canada's most recent profit was $2.1 Billion. I wonder how much of that profit was generated by people like me who didn't realize they were paying for services they hadn't asked for and weren't using.
Many years ago after using pay as you go plans, I decided to get a dedicated cell phone with a number and all the gadgets. At that time there were 3 cell phone providers in Canada. As it was more or less six of one and half a dozen of the other (actually 3 of 1 and a quarter dozen..) I ended up with Bell. Up until now Bell has not been bad to me, they have not been particularly good to me either. Periodically Bell calls me and tells me that my contract has been extended. They never ask me if I want it extended and I never argue.
I also signed up for e billing. I hate filing phone statements and as they were automatically debiting my card and am going to lose any fight over the statement anyway (as I found out) so why use it. I had to chose a user name. The usual user names, my first initial and last name or vice versa weren't available so I chose another user name which I of course forgot.
About a year and a half ago I got an i phone. As I was still under contract with Bell, I picked it up at the Bell kiosk in the mall and got a new data plan which enabled me to surf the Internet with my phone. Of course they tell you that you get X number of free bytes of downloads but neither I nor the salesman actually know what that amounts to in the real world. I of course knew that the monthly cost they quoted was nowhere near what I was going to have to pay. When a cell phone company tells you your service is going to cost $X, it is about the same as the surgeon telling you he is only going to take an hour.
By September of 2010 I was so attached to my i phone that when I went to Europe I wanted to be able to use it. I phoned Bell on the #611 number explained that I was going to Europe and wanted to be able to use my phone and download data and the nice lady at the call centre sold me a package. Because my visit overlapped my billing period she said I would have to pay for two months which is a bit of a rip off but hey Bell are not the only people who do things like that. Off I went to Europe where I was able to use Google maps, phone home, receive texts and even almost got a call from the one patient who has managed to get my cell number (I recognized the number and didn't answer). When I went to Africa in June, I spent a couple of days in Belgium and just to check I tried to use my i Phone and got no service.
I continued to see these bills for Bell on my credit card statement and they were a little high but not excessively high so I just figured I must be downloading too much. I kept saying that I should really look at my statement but I had forgotten which of the alternate user names I used and the only way to find out was to log on to Bell's site which of course required my user name. I suppose I could have just called #611 but I really didn't feel like spending time on hold when I have more important things to do like blog, go on Facebook and watch Big Bang Theory re-runs.
Just last week, I tried to log on again and much to my surprise Bell had upgraded their website so that it was actually possible to find out what my user name and password were. I still didn't get around to checking until today. That was when I found out that I had been charged $60 a month for the past 14 months for service in Europe that I wasn't using (I promptly cancelled it on line). I promptly phoned #611 and after a surprisingly short wait (at 0900 on Sunday morning) I talked to a customer service rep who informed me that she could refund the past three months but that was all. She pointed out that I should have checked my statements, I pointed out that I had not asked for more than 2 months service and that if I had planned to relocate to Europe, I would have bought a cell phone there for considerably less than what it costs in Canada. I of course got nowhere. I told her that while I was under contract until 2012 or 2013, I would definitely not forget this and I would be using a different cell company assuming they haven't all amalgamated by then. She seemed unconcerned. Obviously not a shareholder.
So okay, I should have checked my statements. I might even have picked up on it earlier. But that logic is like saying, it was okay for me to burglarize your house because you didn't lock the door. Or say Bell through some glitch forgot to bill me for the past three months, do you think I would have gotten away with saying, "Sorry you should have checked your statements?"
I can of course afford this. My cell phone is paid for by my PC and so it is tax deductible. $700 isn't that much in the scheme of things. But $700 here , $700 there and you're talking real money.
Bell Canada's most recent profit was $2.1 Billion. I wonder how much of that profit was generated by people like me who didn't realize they were paying for services they hadn't asked for and weren't using.
Sunday, 4 December, 2011
The Golden Rules
I found this blog post on facebook.
It made me think. When was the last time you saw a doctor getting heroic chemotherapy or having a "metastasectomy" or a tumour debulking. Or for that matter saw a doctor on a ventilator. Or having a redo CABG. Or attended a Code on a severely demented doctor with no DNR order.
My son took biomedical ethics course. No.... he is not in medical school, doctors don't take ethics courses but we did actually have some discussions about ethics. I have a little problem with ethics as it tends to be jargon focused but I thought about this and sad basically ethics comes back to the the Golden Rule: Treat others as you would treat yourself.
So the question is: why are we treating patients in a fashion that we would never ask for either for ourselves or our families?
Just asking.
It made me think. When was the last time you saw a doctor getting heroic chemotherapy or having a "metastasectomy" or a tumour debulking. Or for that matter saw a doctor on a ventilator. Or having a redo CABG. Or attended a Code on a severely demented doctor with no DNR order.
My son took biomedical ethics course. No.... he is not in medical school, doctors don't take ethics courses but we did actually have some discussions about ethics. I have a little problem with ethics as it tends to be jargon focused but I thought about this and sad basically ethics comes back to the the Golden Rule: Treat others as you would treat yourself.
So the question is: why are we treating patients in a fashion that we would never ask for either for ourselves or our families?
Just asking.
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