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Letter From Dr. Carron

The Caring Physician

Most of us went into medicine with the idea of helping others. Certainly, the thought of having a good lifestyle and earning the community’s respect crossed our minds, but the hours spent in training, debt amassed and limited salary for so many years are far too burdensome to go into medicine for the money. Even when we are making a good salary, the time away from our families, stress, and often moral injury we suffer in caring for patients can make us both forget and question why we went into medicine in the first place.

Last summer I was having some nondescript symptoms ultimately leading to a decision to have an EGD. My Osteopathic internist is part of a large multi-specialty group whose practice is that if you are seen by one of the internists in the group and referred to GI in the same group, you do not need to be seen by GI in office prior to a procedure. I was grateful to save the time for another office visit.  I am at a new hospital, so do not know many of the docs yet. 

In pre-op holding, the gastroenterologist came to say hello. He stood behind the bedside table and nurse and said, “Hello, so you are here for your routine colonoscopy?”  I said, no, I am here for an EGD, referred by an internist in your group. He said “Oh, ok, see you after the procedure.” No questions about my symptoms, no exam whatsoever, never even came around the bedside table. He then moved to the bay next to me when I heard him say, “Hello, so you are here for your routine colonoscopy?” That patient replied, “No, doc, I’m here because I am bleeding. Don’t you remember me? I have some things I need to talk to you about.” The doctor’s reply was, “Oh ok, I will see you after procedure.” He never discussed the patient’s concerns with him. 

After my procedure, I recovered and was dressed and waiting for the doctor to come discuss findings. The nurse had said there were some abnormal findings. After 20 more minutes or so, the nurse said, “Sorry you are waiting. You were the unlucky one to go first. He comes out only after every two procedures to talk to patients.” After another 15 minutes, the gastroenterologist came out, waved at my husband and me, said “Everything’s fine,” and kept walking. I yelled, “But the nurse said some things were abnormal and I wanted to discuss my symptoms.”  He replied, “Nothing big. Make an appointment for the office.” 

The nurse then brought my discharge instructions and they were instructions for post- colonoscopy. I brought this to the nurse’s attention, and she laughed and said, “Oh, he does that all the time,” and used her pen to cross off colonoscopy instructions and handed them to me. 

After having had the opportunity to review my records the next day, the procedure report was correct, but it indicated there was a complete H&P done with full exam and assessment stating “53 y/o female patient,” and plan stating “routine colonoscopy.”

I could not discern from the timing if he actually did an H&P before he even saw me, but he clearly made no connection between me as a patient and his documentation.
It was the most dehumanizing thing that has ever happened to me. Not to mention, I lost sleep over the poor guy next to me, wondering if he ever had his bleeding addressed, or if he would be my next palliative care consult for missed/poorly treated metastatic colon cancer. My first response was wanting to report this doctor to the state medical board. I handled it differently, but I regret not reporting him as he was not scared enough. It took him six months to correct my H&P. 

While I do not personally know this doctor, I have to believe this is not what he imagined his practice would be like. He is overscheduling himself. Is it for the money? Is it because of pressure from his practice to bill more RVUs? Is the paperwork limiting his time to spend with patients? Have you ever documented all or part of an exam you didn’t do? Do you have nurses making excuses for your behavior? (A systems sentinel event waiting to happen).

How much money do we really need? 

Do you remember why you went into medicine?

ACOI has worked diligently over last several years to develop a plan to help our members stay true to why they pursued medicine. Principle-Centered Medicine puts down on paper in a new, real way, how to redefine Osteopathic medicine for the 21st century. You will see a lot more about this in the near future. It is guiding ACOI in how we develop our continuing education and other resources to help doctors/students maintain a sense of control though community, leadership, education and wellness. Sign up for one of our online or live activities now and stay posted! 

Annette Carron, DO, CMD, FACOI, FAAHPM