But the Doctor gave the order! Who are YOU to override a doctor?

Plot Device · May 13, 2010

This makes me very angry. I'd like some opinions from the medical profession folks here. Thanks ahead of time.

EXECUTIVE SUMMARY: My friend went to her semi-annual appointment with her OB/GYN last month and he found a small lump in her breast. He ordered a mamogram AND an ultrasound back-to-back all in the same visit. He also scheduled for a consultation between her and a surgeon to happen the next day. The appointment for both of those procedures was yesterday, so her meeting with the surgeon is today. Meanwhile, she went to get both tests done yesterday (mamogram and ultasound together). They performed the mamogram on her. But then they refused to perform the ultrasound saying: "You don't need an ultrasound, dear." This determination came from the radiologist who doesn't even know her, or her history. And he didn't even have the decency to tell it to her face but instead had a nurse relay his refusal to her.

EXTENSIVE DETAILS: My friend has a history of lumps. She has VERY fibrotic breasts and has already had five benign lumps removed over the past ten years. And she told me that the doctor educated her to the fact that with each new lump they find, the chances of "the next one" being cancerous just increase all the more. The three most recent lumps that have been removed were all so small that they did not show up in the mamogram at all, so the ultrasound has been coupled with the mamogram repeatedly by this one doctor of hers as a backup in the detection process.

When they told her "no ~~soup~~ ultrasound for you," she chose not to argue and just left. She said, "I'll see the surgeon tomorrow. He'll just have to make his decision without the ultrasound."

Meanwhile, she has a good job with good benefits. The insurance WOULD HAVE paid for the ultrasound. She WAS booked for that exact time frame for that ultrasound, so it was her time slot, and it was no one else's to take.

I just can't get over the audacity of disregarding a doctor's order, and taking her appointment/time slot from her.

Risk/benefit anyone???

.

cray · May 13, 2010

no offense but read post 8 and 12 of this thread. very good posts.

veinglory · May 13, 2010

It might have been worth going over the radiologist's head. He does not have the discretion he seems to think he does.

Plot Device · May 13, 2010

cray said:
no offense but read post 8 and 12 of this thread. very good posts.

No offense, but I am not seeking medical advice. I am seeking opinons on the correct procedures and protocols that are supposed to happen in the medical profession.

::ETA::

Actually I am a little annoyed with you over your misunderstanding of my intent. But I don't care. I'm sure I'll get some good opinons from others here.

Plot Device · May 13, 2010

veinglory said:
It might have been worth going over the radiologist's head. He does not have the discretion he seems to think he does.

Why would he think he does?? Anyone here work in a hospital and seen this kind of override take place??

veinglory · May 13, 2010

You can inquire as to who the manager of the facility is (go straight to the top) and send them a detailed description of what occured (name, time, place) and statement fo your objection. I suspect that would have some results.

Plot Device · May 13, 2010

veinglory said:
You can inquire as to who the manager of the facility is (go straight to the top) and send them a detailed description of what occured (name, time, place) and statement fo your objection. I suspect that would have some results.

It's not my breast to complain about. And she says she just can't deal with that kind of red tape right now. She'll see the surgeon this afternoon and wait for his opinion.

kayleamay · May 13, 2010

Where I work, this wouldn't happen unless the radiologist called the MD to verify that he really wanted an ultrasound and the MD canceled the order. I can't say that's what happened here though. A lot goes on behind the scenes, so your friend may want to bring this up with her doctor for an accurate explanation. I think chalking it up to the audacity of a radiologist is taking a big leap with little info to go on.

veinglory · May 13, 2010

If the radiologist was not acting unilaterally perhaps he should have explained that to the person who owns the breast in question. They really shouldn't be left to wonder why a diagnostic tool is being withheld.

Plot Device · May 13, 2010

kayleamay said:
Where I work, this wouldn't happen unless the radiologist called the MD to verify that he really wanted an ultrasound and the MD canceled the order. I can't say that's what happened here though. A lot goes on behind the scenes, so your friend may want to bring this up with her doctor for an accurate explanation. I think chalking it up to the audacity of a radiologist is taking a big leap with little info to go on.

She asked who made the determination that no ultrasound was needed, and the nurse said it was the radiologist. And the nurse was SOOOO kind and SOOO comforting and SOOO fucking condescending with her coo-cooing strains of "Oh, I'm sure you're worried, but chances are this is all just nothing."

Chances are??? Chances are???

The thing about "chance" is it's exactly that ... chance. So rather than going through life chancing our way through circumstances we have this thing called science to help us get the upper hand on chance. And ultrasounds are part of that science. (What a stupid kiss-up of a nurse she was!)

Plot Device · May 13, 2010

veinglory said:
If the radiologist was not acting unilaterally perhaps he should have explained that to the person who owns the breast in question. They really should [n't??] be left to wonder why a diagnostic tool is being withheld.

I totally agree. And the damned radiologist didn't have the balls to tell her to her face but instead sent the nurse to tell her. Grrrrrr!

Sheryl Nantus · May 13, 2010

Tell it to the surgeon and see what he says. If he feels that it's justified, he'll reschedule it and sees that it goes through.

Plot Device · May 13, 2010

Sheryl Nantus said:
Tell it to the surgeon and see what he says. If he feels that it's justified, he'll reschedule it and sees that it goes through.

I am hoping that when she tells the surgeon about the denied ultrasound that:

a) someone gets in serious trouble over this one

and

b) the rescheduled ultrasound is done TODAY, and not 2 weeks from now.

Sheryl Nantus · May 13, 2010

Plot Device said:
She asked who made the determination that no ultrasound was needed, and the nurse said it was the radiologist. And the nurse was SOOOO kind and SOOO comforting and SOOO fucking condescending with her coo-cooing strains of "Oh, I'm sure you're worried, but chances are this is all just nothing."

Chances are??? Chances are???

The thing about "chance" is it's exactly that ... chance. So rather than going through life chancing our way through circumstances we have this thing called science to help us get the upper hand on chance. And ultrasounds are part of that science. (What a stupid kiss-up of a nurse she was!)

Frankly, I'd lay off beating the nurse. She doesn't make the decisions and it's not her place to dictate this or that.

It's her JOB to try to be consoling to people as much as possible. What would you want her to say?

Don't shoot the messenger, in other words. It's a thankless job at times and nurses do the best they can even when placed in a bad situation.

Plot Device · May 13, 2010

Sheryl Nantus said:
Frankly, I'd lay off beating the nurse. She doesn't make the decisions and it's not her place to dictate this or that.

It's her JOB to try to be consoling to people as much as possible. What would you want her to say?

Don't shoot the messenger, in other words. It's a thankless job at times and nurses do the best they can even when placed in a bad situation.

My apologies to nurses everywhere.

cray · May 13, 2010

Plot Device said:
No offense, but I am not seeking medical advice. I am seeking opinons on the correct procedures and protocols that are supposed to happen in the medical profession.

::ETA::

Actually I am a little annoyed with you over your misunderstanding of my intent. But I don't care. I'm sure I'll get some good opinons from others here.

excellent. seek the advice of relative strangers on the internet in a matter that is important to you. carry on.

benbradley · May 13, 2010

Plot Device said:
This makes me very angry. I'd like some opinions from the medical profession folks here. Thanks ahead of time.

I'm no medical professional, but clearly the radiologist was in the wrong, and should be somehow disciplined. It looks to me he's about this close >< to being charged with practicing medicine without a license. Okay, maybe the last statement is a little over-the-top, but it was absolutely not his decision to make.

Plot Device said:
Meanwhile, she has a good job with good benefits.

And better things to do than go to another appointment for the ultrasound when she should have got it done already.

Plot Device · May 13, 2010

cray said:
excellent. seek the advice of relative strangers on the internet in a matter that is important to you. carry on.

Yep!

Office Party is the place to do it!

::ETA::

Oh and ... my writing is also very very important to me so ... I get lots of advice here at this web site on that aspect of my life too.

Plot Device · May 13, 2010

benbradley said:
I'm no medical professional, but clearly the radiologist was in the wrong, and should be somehow disciplined. It looks to me he's about this close >< to being charged with practicing medicine without a license. Okay, maybe the last statement is a little over-the-top, but it was absolutely not his decision to make.

Meanwhile, she has a good job with good benefits.

Click to expand...

And better things to do than go to another appointment for the ultrasound when she should have got it done already.

That's my feeling, Ben. As a radiologist, he's certainly a doctor (like her OB/GYN is a doctor) but he's not a frigging damned oncologist, not by a longshot he ain't. Nor does he know her medical history. I again want to ask the question: risk/benefit??? Any takers on the risk/benefit ratio here of his indefensible decision???

And yeah, her job is demanding. She needs to be at work.

Plot Device · May 13, 2010

One thing I am really looking for here in this thread:

Has anyone here who has worked (or right now works) in a hospital ever seen someone's ultrasound get bumped for reasons that were NOT in the best interest of the patient? Like maybe ......

-- The ultrasound machine got accidentally overbooked?
-- The radiologist wanted to punch out early that afternoon?
-- The radiologist was having a conflict with the doctor assigned to the case and so he/she honestly didn't want to deal with THAT doctor?
-- Other?

I am asking because I just can't fathom denying a patient a doctor-ordered procedure for no other reason than, "Oh, you don't need this procedure, dear." Something's rotten in Denmark.

.

NeuroFizz · May 13, 2010

I'm not going to point a finger in one direction because I think both sides could have done better.

One thing we all forget at times is that we are the consumers in our medical care. If we don't think we are getting our money's worth when someone repairs one of our appliances, we darn sure will say something. Why don't we speak up when we don't think we are getting what we need from our medical professionals? The woman should have explained her situation. If she had, her medical professionals should have listened and acted accordingly, including contacting her original doctor.

And in answer to your last question, PD, maybe the combination of the two tests is not routine and considered redundant by that current medical staff. Maybe that and the doctor was trying to keep costs down for the patient. In this last instance he/she may have had the interests of the patient in mind and therefore was acting in good faith. This not an excuse--the doctor should have inquired about the paired tests, either to the patient and/or to the original doctor.

This, however, underlines one of the problems with our current health care system, where everything is farmed out to specialists so there is no real ownership of the patient's best interests, just what is best for the faceless, average patient (or what the insurance company sees as that average patient).

Plot Device · May 13, 2010

NeuroFizz said:
I'm not going to point a finger in one direction because I think both sides could have done better.

One thing we all forget at times is that we are the consumers in our medical care. If we don't think we are getting our money's worth when someone repairs one of our appliances, we darn sure will say something. Why don't we speak up when we don't think we are getting what we need from our medical professionals? The woman should have explained her situation. If she had, her medical professionals should have listened and acted accordingly, including contacting her original doctor.

And in answer to your last question, PD, maybe the combination of the two tests is not routine and considered redundant by that current medical staff. Maybe that and the doctor was trying to keep costs down for the patient. In this last instance he/she may have had the interests of the patient in mind and therefore was acting in good faith. This not an excuse--the doctor should have inquired about the paired tests, either to the patient and/or to the original doctor.

That can make sense on one level. But it's a condescending position for the radiologist to opt for, and it takes empowerment away from the patient and away from the OB/GYN.

NeuroFizz said:
This, however, underlines one of the problems with out current health care system, where everything is farmed out to specialists so there is no real ownership of the patient's best interests, just what is best for the faceless, average patient (or what the insurance company sees as that average patient).

That is where my main compaint lies: this patient, with her history, has need of both procedures, regardless of whether the "chances are" that most of the time such a lump is just nothing. Overriding another doctor's decision in the instance just ain't kosher, and was not in the MEDICAL interests of that patient, (insurance be damned).

The #1 rule in medicine is "Do no harm." I see serious potential for harm in denying her this ultrasound, but almost no potential for harm in giving it to her. So just WTF was he thinking in denying it of her? Risk/benefit ratio, folks. Risk/benefit keeps rearing its head in my mind.

.

NeuroFizz · May 13, 2010

Plot Device said:
That can make sense on one level. But it's a condescending position for the radiologist to opt for, and it takes empowerment away from the patient and away from the OB/GYN.

Yup. It's sad, but our current health care system tends to pay only lip service to a patient's say in his/her medical care due to "chain of custody" problems as I mentioned in my earlier post. All the more reason for us all to become more informed of our medical situations and more demanding of answers and reasons for our prescribed medical services. And the doctors have to be more honest with patients. If they are limited in what they are allowed by "rules" imposed by insurance companies, they need to tell the patients exactly that. This could have been an insurance issue, not a medical issue.

Either way, the patient should not just let this go, even if it is after the fact. She should at least be given a reasonable explanation as to why the original doctor's orders were not followed, and the original doctor should be put in the loop.

Plot Device · May 13, 2010

Thanks, NF.

(Now I'm waiting for Colorado Guy to chime in.)

backslashbaby · May 13, 2010

I don't know how this happens, but it does.

I go to another place, after discussing with them that I want the ultrasound and that I'm not interested in a 'second opinion' without an ultrasound. I call it a second opinion and that seems to work.

Sucks though. And is costly.

If she's not yet 40, does she have a strong family history? I have to bring up my strong family history and the attitudes change completely. There are very different protocols, apparently (yes, even for the imaging folks).

Same with the liver/kidney at my age -- the pain meds history changes the protocol entirely. That sort of thing. You do have to remind them, oddly...

But the Doctor gave the order! Who are YOU to override a doctor?

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