Health care provider, frustrated with patient's or guardian's attitudes

[southernbelle_amy]

OP, I can understand both sides of the story. While I don't think an apology is needed, I think it might be a good idea to put a note in their computer file to not have you see the kid, if you can do that.

We do have electronic medical records. Unfortunately the program for scheduling, with the front office is different. So although there should be a “note”, it is hard to coordinate the two.

I just want to say again, that I knew the patient’s history, once I saw him, because I remembered him. Again we see a lot of repeat patient’s so I think it is a good thing that we can remember, instead of always reviewing the chart. Of course in this case I realize it didn’t help since I didn’t recognize the name.

 

[Tink888]

I hope I can explain this. I am a PA (physician assistant) at a pediatric practice. Honestly every day I expose myself to various illness, without much hesitation. However, I am close to 6 months pregnant so some illness I try or the nurses try to avoid, but sometimes we are unaware until it is too late.

Well today there was a kid that is about 6 months old whose chief complaint was cold and cough symptoms. Well, I went into the room, and recognized the kid. He has a history of neonatal Herpes Simplex.
Before his grandmother could start I asked, "Is he the one with a history of Herpes?". She immediately got defensive and said, "yes, but that is not what he is here for he has ............ etc". I said well, "I really think it was be best for the doctor to see him because I am currently pregnant, and due to his history". She was still agitated and said how he did not have a current rash, was asking if I had chicken pox before. I again said that I could get the doctor to see him as soon as I could, and finally left the room. And I in no means just ran out of the room.

I told my doctor about this, and then she even recalled that 2-3 month previously, when I had seen this patient before, we had discussed how myself and the other PA who is also pregnant should not see him until after we deliver. We had discussed this with the grandmother and mom.

So the doctor goes in within 5 minutes and sees the patient. She says that GM was "offended" because I acted like he had some "disease". Yet she did remember, that she was suppose to only schedule with the Dr, but had forgot. So my doctor would like me to call her and apologize. Although, she isn't mad at me. (Which doesn't even bother me that much)

What bothers me, is that if I knew I had a serious illness that could negatively effect someone, there is no way I would expect them to see me. Now, would I probably get infected by this kid? Probably not, however, if I did, and the fetus did, it can cause encephalopathy, prematurity, and death. This is serious stuff so why risk it.

I am not even that mad at GM, but I just think it is a sad case of how selfish people can be, when we (Healthcare providers) are doing the best we can. I work where ~80% of the patients are Medicaid, and a lot of them do have a sense of "entitlement", like we are just there to serve them. I also thought about if something were to happen, it's not as though, she is going to pay for it or even care. Although, my tax money is helping paying for his treatment. (of course health care policy, is not what I want to debate). I try for my sanity and my patients to not become cynical, but in these situations it is very hard. Sorry this is so long, but it really just bothered me. Vent over.

I'm with the others in the camp that you handled the situation poorly. I realize it was just a vent and I agree and sympathize with you in wanting to put your health and the health of your unborn child first.

I disagree with your comment about the Grandma feeling entitled and scheduling the appt with you. You stated she said she forgot. You work in a medical office, you provide a service (regardless of who pays for it). It shouldn't have been the Grandma's responsibility to remember not to schedule with you. To me, the computer system in your office should have flagged it and caught it when the appt was made. You have to understand that patients aren't really thinking about that stuff in the months in between visits, nor should they be expected to KWIM?

Once you recognized the boy, you could've excused yourself from the room, quickly reviewed the chart to confirm your suspicion and had someone else go in there and see him. As a parent, I would've been offended by the way you acted. A simple "the PA had morning sickness excuse (along those lines) and I'll be seeing you today instead" from your replacement would've been a good enough explanation

Should the Grandma have known better? Maybe. As a medical service professional should you have known, handled and acted better? Definately.

It doesn't take much to offer an apology and it would go a long way toward your practice promoting goodwill to your patients.

 

[Liberty Belle]

You've been asked to apologize to the patient, OP. Obviously something went wrong in this situation.
You could take the opportunity to take a step back and learn something from the situation, if you choose.

-I apologized when leaving the room and tried to call her. And yes I was asked to apologize by my M.D, to “smooth” things over, but I don’t think she thinks I am in the wrong. Trust me she has apologized for things too. I am not trying to say I can’t learn from this situation. I was just highly upset about it.


Yes, of course. And pregnant teachers are exposed to Fifth's all the time. It goes with the territory. If you are that concerned, why are you not either taking precautions or taking a leave until after your child is born?


-I’m not that concerned, that is the point, I have to deal with it, I am just saying why is it so wrong, to try to deal with less if you can help it?

Some of you need to read the original post where I said I am exposed to all kinds of illness, without much hesitation all the time. These comments of well you should just go on maternity leave, are just snarky.

I'm certainly not trying to be snarky. It seems to me that you are very concerned, especially when you're talking about something like herpes, which a huge majority of the population has and you're likely exposed to it all the time.

 

[southernbelle_amy]

Well, call yourselves victorus, I am going to watch TV and bed. I am tired of responding to the same questions, since no one is reading for instance, that I did apologize, and did try to call the family. Good night.

 

[Mouse House Mama]

The OP doesn't have a medical degree either but she is charged with the responsibility of taking care of a sick child, and often that includes offering the family emotional support; not insulting them.

-I don’t have a medical degree, but I do have a medical license and obviously studied medicine. Secondly, as previously said I doubt that I am in serious risk, but if I were, it is a serious illness, and my supervising doctor and I had discussed this. It is not about universal precautions.

I have already had to be tested for 5th’s disease or parvovirus, during this pregnancy again due to exposure. Why would I want to have to keep having to worry about illnesses pregnant woman shouldn’t be around if there are other options. Something as innocent as 5th’s disease in most people can be detrimental for the unborn. (Fifth if contracted when pregnant or immuno-compromised (a weak immune system), complications may arise. Transmission of fifth disease from the mother to baby can have serious implications to the health of the baby)

Yes dear, the other option is to find a different line of work. You are bound to run into sick kids at the pediatrician's office. I know that sounds crazy but people actually go there for treatment of illness! Who knew?

The more I read this thread and see your responses the more I am annoyed. You hate people on medicaid. You think every patient should put your health and welfare ahead of their own child. You don't have time to even scan a chart. Hmmmm.... what else did I miss? Oh yeah, you have a medical license but don't know enough to take Universal precautions? Really?
Sorry, but I think if you are that worried and want everyone else to cater to you then you need a different profession. Just the way you keep responding makes me wonder just how charming you are to patients on a regular basis. I would never be treated like that at my Peds office or any office for that matter. It is rude and completely unprofessional and if you did treat me like that I would be writing letters to your boss and the licensing board.

Good luck because I really think you made the wrong choice in careers.

 

[monkey68]

Just curious why grandma should check that you are pregnant before she schedules the appointment? I guess I just don't really see it as her responsibility to see who's pregnant in the office, and who isn't.

Personally, once you recognized the patient, I would have just excused myself, made it seem like you forgot something and had to go back and get it, or just say that the doctor will be with you shortly, and back out of the room, let the MD know the situation. I don't think I would have said anything to grandma about the herpes. I've been in a not similar situation, but close enough... we had one patient in the hospital who just reeked, you couldn't go into his room without gagging. I ended up making my pager go off, excused myself and went out of the room. I needed to put some vaporub or something under my nose to limit the smell, because there was no way I could go back in there and do an exam with the way he smelled. Patient never knew that I left because he stank to the high heavens, and I was able to come up with a solution from my end.

 

[Sabeking]

Amy,

I can see both sides of the coin and have been on both sides unfortunately;as a parent and care provider. Maybe you could have handled it a little better. In this day and age texting, emailing, etc... leaves your account of the situation and the reply of others to be interpreted by everyone with no verbal conversation which can totally confuse the intent.

Anyway, being pregnant makes most women (me included when I was) have less patience for people who we think are not taking our well being into consideration. I think you had a valid concern and the grandmother also had a valid point. Things happen and you learn from them and maybe the grandmother learned to consider prior agreements she has made.

Bottomline, I am sure you are a fine PA who had a bad day. For some to say you need to take a leave or hammer you is ridiculous. I hope all is well with your new child. They are certainly a gift. My 2 cents

 

[Pigeon]

You are a health care provider. Your patients are going to have medical histories. Maybe they didn't mention that in your training. If you choose not to provide care for people with certain conditions, it is your responsibility to avoid scheduling appointments with those individuals, or it is the responsibility of the people in your office who do the scheduling.

It is certainly not the responsibility of the patient to ascertain the health status or risks to the provider of what is a very common condition. If I were the patient's guardian, I'd be livid.

I think you were way out of line, and if it bothers you that much to be around people with medical conditions while you are pregnant, it is time to start your leave.

I'm not sure what exactly you were expecting here.

 

[teacups]

like we are just there to serve them.
.

First I want to say I am sorry you were exposed. I hope you and your baby escape any harm.

Secondly... and I wont be popular... but you actually ARE there to serve them, right?

I do think YOU should make sure you treat healthy kids... not make them keep up with your health. My doctor always walks into the room with my chart in his hand. He knows who's in the room and why before hand. Maybe you could get a system like that going where you work.

 

[mhsjax]

You all may have great providers, I hope you do. But unless it is a specialist, you all are all "naive" to think your doctor knows your life's history, and never makes a mistake.
I was seen at the OB/GYN today and my visit was less than 5 minutes from a person I had never seen before. I had to ask are you okay with this or that since last time I had a problem with it, it wasn't like she knew. Maybe she should find a new career too.
As for that, I know I am good at what I do 95% of the time. I have rough days same as everyone else. And just because I am here to serve people, doesn't mean I like to get ran over.

OP, I do understand what you are saying. I am not a Dr or a nurse. I have worked in a medical office for about 15 years total. I was pregnant, and we were going to see my mother in law. I was 6 months pregnant. She called and said oh, by the way I have shingles but they are just about gone. I called my OB GYn and he said "NO WAY" should I go see her. Anyway, I also understand about the entitlement comment and I am right there with you. Also to the poster who wants the Dr to take a few minutes to review that chart before you are seen. IT doesn't work that way, they don't have time, and If they made the time the patients scream about them taking too long. It is a no win situation. As for the person who asked why did so many DISers with no medical back ground place judgement. Silly person, haven't you realized that DISers are perfect. (note sarcasm). I won't debate any of my comments so no flames because I won't respond. My Rant over.

 

[Mickey's Minion]

Just a note that some docs have gone to all electronic charts. The military docs have them, they don't have a chart in hand when they walk in.

OP, I can understand both sides of the story. While I don't think an apology is needed, I think it might be a good idea to put a note in their cimputer file to not have you see the kid, if you can do that.

You are absolutely correct, many docs have gone to all electronic charts. Two of my docs, my PC and one of my specialists are both completely electronic.

In both practices, there are computer monitors in each exam room. The nurse brings up the patient's file and does a quick review of the chart while taking temp, etc.

My PC physician walks in with her notebook (computer), and is reviewing as she walks in.

My specialist sits down at the monitor and takes a minute to review as he is asking questions.

The time you took to ask the Grandma if "he was the one with herpes" could have been the time you checked the chart for yourself. I don't buy the "I don't have time to look at charts." You had time to embarrass the grandma, surely this time could have been spent doing a more professional task.

 

[Forevryoung]

southernbelle_amy, much like my paid paramedic (sorry, paragod ) counterpart, DanMedix and yourself, I am both an EMT (volunteer) and a speech pathologist. I KNOW where you are coming from.

I think until you walk in similar shoes, you don't realize the bigger picture.

 

[digitaltim]

I think until you walk in similar shoes, you don't realize the bigger picture.

What is the bigger picture?

 

[allison443]

southernbelle_amy, much like my paid paramedic (sorry, paragod ) counterpart, DanMedix and yourself, I am both an EMT (volunteer) and a speech pathologist. I KNOW where you are coming from.

I think until you walk in similar shoes, you don't realize the bigger picture.

Yes, but do you have a "medical degree"? According to a prior poster, you cannot comment on this unless you have a medical degree!

 

[bumbershoot]

I don't know why a patient, who doesn't even *think* about you after they leave the room, is supposed to keep your pregnancy status in mind while making an appointment. An appointment with people who have a computer system that is different from the files you guys have, as you recently stated, and therefore could be flawed/different enough that it doesn't catch that she's supposed to book with someone else.

Just last week I saw a girl with a 104.9 fever that ended up with H1N1. After discusing the patient with my doctor, she was like I can go in so you don't get more exposed, to little to late, I just went ahead and finished seeing her.

The person at the grocery store might have it too. The cashier who gives you your money might have herpes. If you are THAT frightened of these illnesses right now, and if you arent' comfortable wearing gloves and a mask everywhere, you really should take a break from your job and perhaps from going out right now.

People with germs are *everywhere*. They cough on strangers all the time. You either need to just wear gloves and a mask at all times in the office, or you need to stay home.

You all may have great providers, I hope you do. But unless it is a specialist, you all are all "naive" to think your doctor knows your life's history, and never makes a mistake.
I was seen at the OB/GYN today and my visit was less than 5 minutes from a person I had never seen before. I had to ask are you okay with this or that since last time I had a problem with it, it wasn't like she knew. Maybe she should find a new career too.

It's possible she should. What was the point of that visit? Do you feel safer, most confident in your pregnancy now that you had your appointment?

That sort of group practice, where you cycle around and meet everyone through your appointments, helped cause my friend's ecclampsia and 25 week emergency delivery. The doc said "your BP is normal". My friend said "that's NOT normal, I have ALWAYS had very low BP, that is not OK that I'm normal today." He blew her off; he didn't know her, didn't know her history...turns out it was very very very NOT normal, and it took about a week, after she came out of it, for her husband to convince her that she had been pregnant and they had a baby in the NICU (happy 6 year old now).

IMO that sort of OB practice is dangerous...so yeah, maybe the OBs there need to rethink things.


And you're talking to people who see healthcare providers. We're not being naive. We're telling you what we EXPECT.


Local healthcare conglomerate, Multicare, just started a billboard campaign. "How are you, not Who are you". Saying...they know you. They know you before they see you, they remember you, they don't have to figure out who you are and what your history is.

Multicare is providing this as a service because they know people are demanding it.

Provide it. Don't walk into that room if you can't take care of that patient because of your own personal issues right now.

And if you walk in, hey, you're pregnant, built in excuse. I'm sorry, I have to pee RIGHT NOW. And out you go.

I have already had to be tested for 5th’s disease or parvovirus, during this pregnancy again due to exposure. Why would I want to have to keep having to worry about illnesses pregnant woman shouldn’t be around if there are other options. Something as innocent as 5th’s disease in most people can be detrimental for the unborn. (Fifth if contracted when pregnant or immuno-compromised (a weak immune system), complications may arise. Transmission of fifth disease from the mother to baby can have serious implications to the health of the baby)

Yes yes, most people know this. And at the library, I'm sure there are people with it. At the movies. At the hair salon I'm sure there are parents with it floating around them, or on the kid they have with them that day...

Patients and their families do not always understand the gravity of a situation. They want what is familiar.

In regards to ambulances...and patients also sometimes just don't want to go to a hospital they refer to as the Place of Death, where they were almost killed, where their FIL was absolutely killed because of the incompetence rampant, and where a friend's father had the EXACT thing happen to him as my FIL did, and he died as well. Some of us will get up and walk out, if taken to that hospital against our will...

I think that maybe ambulance companies need to start listening to patients as well and having some empathy for their reasons...

So I guess, after reading your all's posts I have decided to quit my job and become a hermit, since I am sooo scared of every illness out there.

But you ARE scared of an illness that you can't catch just by being in there, and you can put barriers on to prevent getting it, and the grandmother TOLD you he wasn't having an outbreak.... And you've mentioned a very common disease that's everywhere kids are, that you are worried about and have been tested for.... You're saying it sarcastically like you are NOT afraid...but you very obviously are. Take some time off. This can't be healthy for you.

Yes, of course. And pregnant teachers are exposed to Fifth's all the time. It goes with the territory. If you are that concerned, why are you not either taking precautions or taking a leave until after your child is born?

Exactly.



My chiropractor (I'm a retired one) was recently pregnant and worked right up until the end. DCs routinely tell/ask their patients who are trying to cancel because they are sick, to come on in, and she's no different. No gloves, no mask, no nothing, just come in, let me help you out in this way, so you can get better faster and be closer to 100% health. I'm quite sure that Angie saw people with all sorts of things, and touched them, without gloves (though honestly she uses instruments so she's not as hands-on as I was), that you're worried about. Not everyone is that worried about being exposed to these things as you are, even though they are very likely seeing sick people.

Take some time off.

But don't make your patients' parents keep a track on your own health issues (pregnancy). It's not their place.

 

[barkley]

if your office is all electronic (as far as records/schedualing) AND the doctors you work with are on-board with pregnant staff not seeing patients with certain KNOWN existing conditions is'nt there a way for your appointment system to be set up such to block appointments with that staff or pull up an 'alert' if a schedular tries to book that person with you (or someone else whose pregnant)?

reason i ask is because the medical practice we use is all automated and i know my record is somehow set up to preclude appointments with p.a.'s (i have dual coverage but since one is medicare and medicare won't cover appointments with p.a.'s i can't see them). it's not unusual when i call for an appointment that the person schedualing will start looking for openings and then comment 'oh wait, that one's with the p.a. and your records are coded so i can't schedual you with her'. my md just got back from maternity leave, and they must have coded something into the computer for when she was pregnant-when you'de call for an appointment they would ask what it was for and for certain things they would advise that due to the doctor's pregnancy certain illnesses were being handled by other staff.

 

[wdwmom2]

if your office is all electronic (as far as records/schedualing) AND the doctors you work with are on-board with pregnant staff not seeing patients with certain KNOWN existing conditions is'nt there a way for your appointment system to be set up such to block appointments with that staff or pull up an 'alert' if a schedular tries to book that person with you (or someone else whose pregnant)?

reason i ask is because the medical practice we use is all automated and i know my record is somehow set up to preclude appointments with p.a.'s (i have dual coverage but since one is medicare and medicare won't cover appointments with p.a.'s i can't see them). it's not unusual when i call for an appointment that the person schedualing will start looking for openings and then comment 'oh wait, that one's with the p.a. and your records are coded so i can't schedual you with her'. my md just got back from maternity leave, and they must have coded something into the computer for when she was pregnant-when you'de call for an appointment they would ask what it was for and for certain things they would advise that due to the doctor's pregnancy certain illnesses were being handled by other staff.

The office I work at has EMR. We use what we call "pop-ups". If there is something pertinent, a definite need to know, as soon as we go into the chart a pop-up comes up. You can't miss it, you have to x out of it before you can go on. It also comes up when you try to schedule that patient an appointment. Works very well.

 

[Carly_Roach]

Well, call yourselves victorus, I am going to watch TV and bed. I am tired of responding to the same questions, since no one is reading for instance, that I did apologize, and did try to call the family. Good night.

I recommend you remove the subscription to this thread as well so you won't be tempted to re-open it. The community has it now and won't let it go.

 

[luvsJack]

Well, call yourselves victorus, I am going to watch TV and bed. I am tired of responding to the same questions, since no one is reading for instance, that I did apologize, and did try to call the family. Good night.

You may not come back to read this, but I do think I understand what you are saying. You are concerned about your unborn child and rightfully so. Maybe you could have said things in a better way, but sometimes things are just said the way they are said at the moment.

I do not work in the medical field, but did have a child care center while I was pregnant with dd. I had parents bring their children in to the center sick and one with what looked like measles! We weren't even supposed to have sick kids! The one with measles (or whatever it was) got sent home and told not to come back until we had a note from a doctor saying it was ok. I insulted his mom too, but at the time I really didn't care too much.

The situation is different in that I didn't work in a field where I was supposed to be around sick kids, but if the patient's parents were told not to schedule with you and did, just as the mom knew she wasn't supposed to bring that child around me and did. I don't think it has anything to do with low income and medicaid; but it does have to do with people only worrying about "me and mine" and there is way too much of that these days.

Obviously your office thought the responsibility should be on the patient's family or they wouldn't have told them not to schedule with you or the other PA. You have done what you could, I wouldn't worry too much about it.

 

[sunnyday123]

OP, I can understand both sides of the story. While I don't think an apology is needed, I think it might be a good idea to put a note in their computer file to not have you see the kid, if you can do that.

We do have electronic medical records. Unfortunately the program for scheduling, with the front office is different. So although there should be a “note”, it is hard to coordinate the two.

I just want to say again, that I knew the patient’s history, once I saw him, because I remembered him. Again we see a lot of repeat patient’s so I think it is a good thing that we can remember, instead of always reviewing the chart. Of course in this case I realize it didn’t help since I didn’t recognize the name.

If you remembered the patients history as soon as you saw him, there was no need for you to be so rude. It's not the GM's responsiblity to keep track of your medical history, however as someone in the medical profession, it is your responsibilty. You were rude and unprofessional in your delivery, and if I was the GM I'd be filing a complaint ASAP. And knowing that his particular issue isn't airborne, there was no need to respond the way you did. A simple, "Oh, excuse me" would have sufficed.

You were wrong, and refuse to admit that it could have been handled better.