Unreliability

Every single day hundreds of thousands of patients seek health care and every day something goes wrong. Often it is small things that make the process more difficult, more complicated and more frustrating. Each day patients come to understand that their experience with the health care system will be unreliable.

A patient sees a doctor and a specific laboratory test is recommended. A requisition is received and the patient books the time with the lab to do the test. By consulting with the lab at booking time the patient finds out what the necessary prep is for the test and follows those instructions. The patient arrives at the lab at the arranged time for the expected test only to be told that this is the wrong requisition and that if they don’t have the correct one from the doctor the patient will have to pay for the test.

The laboratory tech tries to be helpful by calling the physician’s office to get the correct requisition faxed over. The physician is not there and may not be there for a couple days. The office staff identifies that he has made this mistake before. They will get him to complete the correct requisition and fax it over when he returns to the office.

So the patient, who has likely taken time aways from work or other obligations, has a choice to pay for the test out of pocket, reschedule as some unknown time in the future, or say to hell with it.

Unfortunately there were many points in this process that could have changed the outcome to complete lab work. At the physician’s office the office staff gave the patient the requisition – they could have checked it and noted what was being requested and noted that it was the wrong requisition. The physician could have been aware of the specifics of this test. The insurance company could deal with their billing issues internally instead of requiring the physician and the patient to ensure that their billing of this test goes through correctly. When the patient called the lab to arrange the test they could have checked that the correct requisition was in hand. The office staff could have faxed in the correct requisition using a physician signature stamp. The lab could provide the information about correct requisition requirements on their website. 

Any of these actions could have changed the outcome, but in the complexity of the health care system it often comes down to the patient being responsible to ensure that all the processes are followed through with correctly. How do patients come to understand what they need to do to make sure that what happens is what is suppose to happen? Are there some ways we, in the profession, can make sure that patients do not bear the brunt of our inefficiency and unreliable processes?

Or maybe we can just be satisfied that patients survive in spite of what we do

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