Keeping your doctors on a short leash

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I always request a copy of my medical record after a doctor’s visit along with a copy of any lab tests or diagnostic imaging that needs to be done.

I got the report for the ultrasound image and ankle-brachial test I had done on Tuesday.

The first line reads “Patient presents with no significant complaints, after angiogram/angioplasty three weeks ago.”

I immediately called the office and complained “That’s not true. I complained that the distance I’m able to walk is declining by the day. And when I get up in the morning, I have discomfort in my right foot that’s relieved by elevating the leg for 5 or 10 minutes. I believe that that’s a symptom of a failed angioplasty and the fact that my popliteal artery is getting occluded again by the 3 cm aneurysm.”

So when I talked with the doctor’s nurse after the ultrasound she seemed to understand the problem. She said I should start taking a baby aspirin to increase blood flow and that Dr. Cook would likely want a CAT scan of the leg to better understand what’s going on with the aneurysm"

The 5 minutes I spent talking to the nurse practitioner was logged as a 30 minute visit, and there was no note of the conversation in the medical record.

Now I’m wondering if anything is being done. So I ask the medical assistant if they’ve ordered the CAT scan and she says, “Oh, that will take a week or two while we get approval from your insurance company”. I tell her, “I’m on regular Medicare. I don’t need an insurance company’s approval, you can send the order to Rayus Imaging today and I’ll get it scheduled.”

Then she calls me back saying, “It looks like we need another diagnostic angiogram, I’ll let you know when we can schedule that.” I tell her that’s not what the doctor and nurse are telling me. I’m pretty sure that the CAT scan is what’s required. (I’ve been spending the last three weeks reading up on popliteal aneurysms, ultrasounds, angiograms and CAT scans and the medical literature seems to show that the CAT scan is the gold standard for popliteal aneurysm imaging because the bones of your knee prevent the angiogram from getting an image of the aneurysm from all sides.)

Now I’m wondering if they have completely screwed up my medical record? When I first talked to the doctor on April 28 during my first visit, he mentioned that I had a lipid problem and plaque accumulation in my arteries. I immediately told him that’s unlikely because my lipids are on the low end of normal.

But the ultrasound report from April 28 clearly states that a 3 cm aneurysm was found in the artery and there is no mention of plaque anywhere. If the doctor had just read a report mentioning a 3 cm aneurysm, wouldn’t that be the topic of conversation in the exam room, and not a lipid problem that I don’t have?

I bet the doctor was looking at another patient’s ultrasound.

intercst

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Man. May be time to get a second opinion or a new doc

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The doctor comes highly recommended. This seems to be a problem of medical record keeping and insurance companies – even when you’re on regular Medicare and you’re not supposed to have to wrestle with an insurance company.

intercst

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Although traditional Medicare doesn’t have the obvious cost containment hurdles that you find with MA plans, it’s a mistake to think that a request for reimbursement by a provider or facility is automatically given the OK. Denials are frequent enough that providers are likely to go through the prior authorisation ritual, even when it’d be reasonable to expect automatic reimbursement…especially as that reimbursement is increasingly reduced.

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We’ve discussed this before. There are very few procedures under Medicare that require pre-authorization. The diagnostic angiogram that the medical assistant is suggesting I need is actually much more expensive than a dry CAT scan which doesn’t require that I be sedated to get another hole punched into my groin to do the procedure and thread a wire.

intercst

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It doesnt really matter when trust is eroded or the system behind the doc is faulty. Its clear youve lost faith in their office and or the doc themselves for not looking through your medical/imaging history or taking the time to make and follow through on recs.

And even the best proceduralists suffer complications when the surrounding staff isnt up to par.

Honestly sometimes best just to start fresh and ask for a second opinion and develop a pt-provider relationship that allows for shared decision making, trust, and informed decisions. Complications happen to everyone and if trust in your provider is already tenious, it just makes it that much harder to treat/recover/trust the course corrections needed to manage the complication.

Also a pop art aneurysm should be something that most vasc surgeons (aside from those that limit themselves to vasc access or angio procedures only) can handle, so theres no risk of alienating the only man/woman capable of doing the job.

Lastly ive seen that patients never blame the doc but will almost always blame the surrounding staff when really we all share the blame when things go wrong. The upset pts are always nice to me after being just rude/aggressive/mean/dissapointed in staff and it really makes me feel for my staff when most of the time they were just doing what i explicitly asked them to do or say

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“Very few” isn’t the same as zero, never ever, under any circumstances. With Medicare reimbursement…and a good many commercial insurances, come to that…as low as it is, providers and facilities are becoming more reluctant to take a chance on not getting paid. I’m sure you can understand that. From your account of your time in the work force, I doubt you would’ve been too thrilled to find that a few hours of your working week weren’t being compensated without warning. Your healthcare providers aren’t going to be much different.

My husband had spent most of his career as academic faculty with a prenegotiated salary and never needed to think about denials or whether patients had referrals or needed pre-auth. Someone else had that burden. Since Covid, he decided not to sign another extended contract so opted for a flexible per diem arrangement. Still a prenegotiated salary independent of individual fees but, for some reason, he gets notification of any claim denial. It’s still Someone Else’s job to sort it out…but it’s focused his lenses a bit on just how close to not actually generating his paycheck he is with a large Medicare demographic (a feature of his specialty)…even when procedures are fully reimbursed.

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This happened far more frequently than I cared for in my practice, and I retired almost 20 years ago…gawd knows what it would be like now. I took to giving my front desk staff permission to charge a $20 annoyance fee under such circumstances…and only half in jest.

I could never understand why folk would want to argue the toss about what their dental insurance would pay for with the person who dealt with dental insurance as part of her job. A good many of my patients weren’t at their best when coming to the office…pain and a few sleepless nights will do that to a person. I operated on the principle of always giving someone a second chance to make a first impression. Except for the person who thought they knew better than my staff did about how I chose to run my business…and why.

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I’m respectful of the doctor’s medical staff and don’t blame them for any shortcomings in the office procedures and business practices. I assume that they are only doing what they’re told to do. And today with the private equity takeover of doctor’s practices, the physician may just be another employee, too, coping with a dysfunctional system. I’m willing to give them the opportunity to correct the errors I appear to have discovered.

Way back in 1991, I had a mass in my parotid gland and I went to an ENT surgeon to get it checked out. She examined the parotid and said that she didn’t feel anything in the gland. At the time I was massaging my parotid glands quite frequently since they sometimes got plugged up due to Sjogren’s disease. I returned to her office about a week later and asked her to examine the parotid gland again, explaining that I massage the glands quite frequently and there’s definitively a lump on the right side that isn’t on the left. I’m assuming that if I’m healthy, the glands would be symmetrical.

So on that logic, she examined both glands for a few minutes and her head dropped and she said, "You’re correct. You have a 1 cm mass on the right side. Given your history of Sjogren’s and the risk of lymphoma we should probably remove it surgically and have it biopsied.

So I went ahead and had the right side of my face removed in a “parotidectomy with full facial nerve preservation” and post surgery, I don’t think anyone has gotten better treatment from a Head and Neck surgeon she was having me come into the office on weekends to change bandages herself rather than have a nurse do it. When the pathology report came back it appeared to be lymphoma but they weren’t sure. The oncologist was ready to get a central line installed in my chest to start chemotherapy, but surgeon said lets wait to get the pathology confirmed. They ended up sending tissue samples all over the country (MD Anderson in Houston, Cleveland Clinic, etc,.) Finally the Armed Services Institute of Pathology in Washington came back with a diagnosis of Castleman’s Disease which is a rare benign tumor of the parotid (incidence of less than 1 patient in 100,000) that is often mistaken for lymphoma. Excising the tumor provides a complete cure, so there was no need for chemotherapy. But they did warn that in rare cases a Castleman’s tumor reoccurs as an aggressive lymphoma that’s usually fatal. So I’m checked from time to time for any recurrence – 30+ years later, so far, so good.

I’m pretty sure that my decision to give the doctor a second chance resulted in VIP care and an excellent outcome.

intercst

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Something like this happened to me in 2024. Had a routine visit to the GP. Later same day was able to view the report and notes online. The entire thing referred to somebody with high BP and diabetes. I responded immediately “Wrong patient! An obvious mix-up on records.” They fixed it but that stuff’s scary

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Holy Toledo, @intercst ! It’s a good thing you are your own best advocate. Sounds like you need a new doctor, STAT!

Sorry to hear that the angioplasty failed. :frowning: I hope you get good treatment and recover soon.

Wendy

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Was it actually another patient (something I also mention to my cardiologist…as in “how can this be me?”)…or has stuff been added to your notes in order to get a test covered by insurance. Yes it happens.

No third-party payer (or patient themselves, for that matter) pays for any and every test without question…regardless of how much value a doctor places on it. One of the features of EMR systems (the manufacturers would call it a safeguard) is that, in order to get reimbursed for a test…say, a Carotid Intima Media Thickness scan…the software prevents the provider from ordering the test without a “correct” diagnostic code. Manifestly, if it’s a screening test or something designed to “rule out…”… like you see on House, for instance…there won’t be a diagnostic code available since there’s no diagnosis.

That’s how come my husband found that he allegedly had a history of TIAs…when, in fact, he had not. I was more bothered by it than he was at the time. It was a different story when we came to choose our supplemental plans and his quote was dependent upon a physician report.

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It was transposed from another patient for sure. It started with “patient presented with…” Wasn’t even the reason I went to Dr that day and my history back to the 1970’s has been LOW BP.

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And maybe a million dollars from the lawsuit!

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Sickening thread :face_with_bags_under_eyes:

I am finding more these on the net, most seem utterly credible, and I thought I would toss this here because the nightmare intercst has gone through fits with this other set of issues:

We are trying to deliver health care as if it were a consumer good when it aint (unless you want deluxe treatment that very few of us even dream of), and that is a radical high system level mess up. My experience in Spain (excellent care) and Mexico (very HQ given the extreme minimization of expenditure) is radically different. The Med staff pays no attention to who pays or how, they pay attention to how do I get the most bang for time, equipment use, and treatment drugs….. “Somewhere, in some cubicle in Madrid, some clerk will stick the cost of your visit with us under some one of the budget lines….” said my discharging nurse in Spain when I inquired as to paying my bill.

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Dr. Elizabeth Potter is such a diehard advocate for her patients. She’s the plastic surgeon who specializes in breast reconstruction who was called out in the middle of a surgery by United Health to discuss why her patient needed what she had recommended. Here’s a video of her talking about what she went through:

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Mark Cuban talks medical industry, medicine, and a zillion other subjects (yes, including TACO guy and etc.) with a youngster to me, but now oldish political colleague of mine, Tim Miller.

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I talked to the doctor this afternoon and laid out what I believed happened, and he said, “Yeh, there was a paperwork mix up and I missed the aneurysm”.

So then I told him that, “I can forgive the paperwork mix up, that stuff happens. But you were clearly surprised by the aneurysm when it appeared on the video screen in the Cath Lab, and that balloon angioplasty you did was likely to close up in a few days since you didn’t do anything to address the aneurysm.”

So he replied, “Well that’s not entirely true, but yes, a balloon angioplasty isn’t a permanent fix for an aneurysm.”

So then I said, “You really needed to call me a day or two after the May 20th procedure, confess to the paperwork error, and then lay out your plan for fixing the problem and making me whole.” Instead, you let me twist in the wind for a month with a bum leg. I have no desire to sue you, but I think you need to contact your malpractice carrier and come up with some compensation for the month I was “twisting in the wind”.

Doctor says, “I’ll do that.”

So then I say, "I noticed that the nurse’s note from my visit to your office last Tuesday says that you ordered an “RLE angiogram (to identify distal target), anticipated bypass.” Is that an endovascular bypass? Or are you doing an angiogram, and there is still a chance that I’m going to need an open leg surgery to repair the aneurysm? If that’s the case, shouldn’t we be doing a CAT scan and not immediately punching another hole in my groin?

Doctor. “I’ll order the CAT scan.”

So then I closed with, “I think this has been a very productive conversation, and I’m sure that I’ll be getting excellent care from your clinic going forward.”

About 15 minutes later a nurse called me asking where to send the order for the CAT scan.

intercst

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Good for you…and good for your doc. No one seems to want to take ownership of errors and not infrequently double down on denying …or even getting belligerent and aggressive in response. I call it “getting your retaliation in first” and is a sure fire guarantee of something fishy going on.

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When I called the imaging clinic to schedule the CAT scan, They said they could do it tomorrow at 3 PM.

I told them, that’s great and confirmed that “The aneurysm is at my right knee.”

The clerk replied, “We got an imaging order for your left leg, but I’ll schedule you anyway and call the doctor’s office to correct the order” {{ LOL }}

intercst

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