Blink, NSTs, and scheduling medical tests in Pennsylvania

In one of the chapters Blink (by the guy who also wrote The Tipping Point), author Malcolm Gladwell talks about doctors who get sued and why they get sued.  But the conclusion Gladwell comes to is unexpected. Doctors don’t get sued for medical mistakes. They get sued because they don’t treat their patients with respect.  Patients feel shuffled around. They feel they are not being listened to or taken seriously.  And on the flip side, the doctors who listened to patients and respected patients in that way were less likely to get sued even if they screwed up in other ways.

Gladwell cites one patient’s desire to sue a particular doctor who she viewed as callous and obnoxious, and not sue another doctor who had listened to the patient and acted in a caring way but who was the one who had screwed up. 

I thought about all this today as I sat in the waiting room for a half hour at my doctor’s office. I was there for my first NST (non-stress test).  Due to my “advanced maternal age” I am supposed to go there twice a week for these tests.  And as I sat there and waited for a half hour I started to get annoyed.  I eventually got up to use the restroom and as I walked back there I heard one of the office staff tell the NST nurse that her first NST had been waiting for 15 to 20 minutes (actually a half hour).  The nurse said “Oh no! No one told me!”  I raised my hand and said that the person was me.  The nurse was very apologetic.

Once in the procedure room, my level of annoyance began to recede. Our new guy is very active, so the test itself did not take very long.

I asked the nurse what the UA read out was, and she said it measured the uterus.  I asked, “what about the uterus does it measure” and she offered some non-answers (appropriate for a non-stress test I suppose) but it seemed like she didn’t really know what it measured.

And that is fine too. I will ask the doc when I see him/her next week.

But then it was time for me to go back out to the desk and schedule two NSTs for next week.

Well, their NST schedule was already full.  The woman who was trying to schedule it called over one of the half dozen people who worked in the front office.  The woman she’d called over said: “I’m leaving now.”  The woman trying to schedule the appointment said: “I thought you weren’t leaving until 11:30,” to which the other woman replied: “I said when I’m done my work.”

(This was interesting because last week when I was waiting in the exam room for the doc to come in, I overheard him talking to a staff member about managing staff. He was telling her that some people would go the extra mile but others acted as if it was a giant imposition if you asked them to do anything extra. 

You know what? Conversations like that just did not happen in Silicon Valley. A completely different culture here to there)

So the woman trying to schedule my appointment called to someone else who looked like she might be some kind of office administrator.  The woman she’d called to replied: “I’m having a conversation with someone else right now.”

It was clear that the woman trying to schedule the appointment was herself getting annoyed at the lack of help she was getting from her coworkers.  She did the big eye movements from the woman to me to indicate, hey, I have a patient here now and I need your help.

So the administrator came over.  She verbally listed the many people who were on vacation next week – the reason why there were no NST appointments available, apparently. She asked me why I needed the NST anyway. I told her “I am 42.”  She said “well maybe you will go into labor and you won’t need the appointments anyway.”   But meanwhile, she told the appointment-setting woman, send her to the hospital to get them.  She said I could keep going to the hospital for them.

She said, maybe those will be the last ones you will need because you will go into labor. Only at that point she actually asked me how far along I was. I told her 34 weeks and then she said, “oh, well you will probably need to keep doing them for a while then.”

I told her I would prefer to keep coming to this office because it is so much closer and it doesn’t charge for parking.

So here’s my thing.  If these had been isolated experiences, no. big. deal. But I’ve noticed a pattern in this practice of a disorganized and inefficient office staff.  Once you get back to see the doc you are normally fine.  But I have been left hanging by the administrative people on more than one occasion. (no real time conversations with the surgery scheduler, inability to schedule needed tests due to too many staff vacations scheduled at the same time, etc.). 

Or, if these folks had taken the time to say: “sorry for the inconvenience but…” or in the case of the surgery scheduler if she’d just made an effort to actually speak to me.  When you are inconvenienced it means a lot of someone acknowledges that you are a human who should be treated better.

This is the kind of thing that annoys people. This is the kind of thing that makes patients feel like a number and like they are not being listened to.

And all this makes me wonder if these kinds of inefficiencies are why Pennsylvania’s malpractice rates are so high (malpractice rate increases naturally following higher than normal rates of lawsuits).

If you follow the logic of Blink, people don’t sue because of medical errors.  People sue because they feel as if they were not listened to, because they feel as if they were not respected.

I felt that way with the surgery scheduler, even though that was eventually resolved. And I felt that way with the office staff today. I felt as if I was a pain in their ass.  I did not leave with a good feeling about the practice.

The malpractice rates are apparently so high in Pennsylvania now that doctors are leaving the state and OB practices are shutting down. No one wants to practice here.  And as that happens, how does that bode for the overall situation? With even fewer people to listen and spend time with patients, will the lawsuits go down or up? Blink says they will go up. 

How bad does it have to get before someone tries to fix it?

Comments

[maggie]

That's terrible. My two cents? When this is all done, and that baby is born, you print out these several posts and send them to the doctor. Or edit them into a letter. The doctors in the practice should know what their staff is doing.

[Jennifer]

I often get questionnaires from hospitals on their services, but never from just the doctor's office. Maybe you should suggest this to the administrator :-)

[Aurelia]

You should let the guy know. I've had to tell more than a few Doctors about lousy staff and the good ones were happy to get the feedback.

[Eva]

Very interesting post.

I can see why you are frustrated. I guess they have so many patients they don't feel the need to try to please the customer.

My suggestion is to mention it to the doctor. Of course you get so little time with them and you probably have a lot of pregnancy stuff to talk about so it would be hard to fit it in.

Or say something after. AFTER YOU HAVE A BABY, THAT IS! (I continue to be really excited about this).

[Avi]

My Silicon Valley experience parallels yours: when I had a job there for a couple of years, the admin staff at my SV PCP's clinic was extremely efficient and courteous). But in have-a-nice-day Berkeley, I have had experiences every bit as horrendous and annoying as you describe, and at several different clinics. They treated me and the other patients like dirt. So I don't know if the difference between SV service and PA service (or between SV and Bay Area) is cultural or anecdotal.

I found your thoughts on malpractice insurance rates so interesting that I did a little Googling -- turns out CA has a handy-dandy little law that limits malpractice awards for noneconomic damages (you know, paltry little things like disfigurement, pain and suffering, distress, accidentally getting the wrong limb amputated) to $250K. (http://www.saynotocaps.org/newsarticles/Rand_Study.htm) Apparently that law was expressly enacted after pressure from physicians, to keep the malpractice insurance premiums down. Instead of stepping up to the plate and having the state government subsidize malpractice insurance (as state government does, btw, in Pennsylvania -- and premiums are STILL at a crisis point there), sunny California decided to take the money from those who need it most -- the actual malpractice victims. ("Patients with the severest injuries, such as brain damage or paralysis, typically had their awards reduced by more than $1 million each. Infants' malpractice damage awards were cut 71% of the time, often by $2.5 million or more.")

[Jessica]

Dude, I've been telling you that Berkeley is overrated!