[Arizona_928]

I was discharged later that Saturday morning. Unfortunately, the shock and blood loss had damaged my heart, kidneys, and affected my thinking and memory. My condition worsened and after undergoing tests locally and at the Mayo Clinic, I was diagnosed with congestive heart failure, stage III kidney failure and chronic anemia. Despite adjustment in medicines, I still couldn’t handle the rigorous requirements of practicing medicine and my daily life, and I was advised by my PCP to stop working and pursue disability.

It was very difficult to accept this recommendation, and I was very angry. I loved my work. I had just moved into a newly remodeled office and, because I was so ill, I didn’t have six months to negotiate the sale of my practice ― I had to close my business. I tried to get a malpractice lawyer to represent me but after six rejections I was finished. Fortunately, I had good disability insurance.

Why do physicians miss a diagnosis or screw up on treatment plans? What’s more, why do too many of them not listen to their patients ― the most basic thing that should be a fundamental part of their practice?

Dr. Woods didn’t really want to consider my concerns, but he and Dr. Smith also failed to put all the pieces of the puzzle together, whether it was because of ego, putting too much importance on my low heart rate, or being distracted by a retirement party. They both had plenty of time for my evaluation and should have thoughtfully weighed my worries.
Unfortunately, my experience is common since adverse events occur in a reported 25% of hospital admissions. If you find yourself in one of these adverse events like I did, here is some advice that may be useful:

1. Resist yelling at the nurse or physician. It doesn’t help, and you may get labeled as “a difficult patient,” which could make matters worse.

2. If you are not being heard, get the unit’s charge nurse or manager involved early in the conflict since any delay may be a life-or-death issue. Because patients are randomly assigned to a hospital-based physician, these nurses can arrange a transfer to another physician’s care or get other specialists involved.

3. If you’re very ill and at a small community hospital, you should consider pushing for a transfer to a larger hospital and, if necessary, contact the hospital’s quality, risk management, or medical director’s office. This almost always guarantees action since no hospital wants to be sued.

4. Outpatient medical practice is very different from hospital-based care. The former is now volume driven and also rife with missed diagnoses, delays in treatment and unsatisfactory office visits. Nurse practitioners (NP) and physician assistants (PA) have similar outcomes as physicians, often have more time to spend with their patients and have high satisfaction ratings. However, ask to schedule a visit with the physician if you’re dissatisfied with the care of the NP or PA.

5. Improving communication with your provider may be aided by bringing another person with you to your appointment and having them serve as an advocate.

The author at home in July 2021.

6. Since computers are now standard in most exam rooms, a provider may only spend 8-10 minutes face to face with you during a 20-minute appointment. Prepare for your visit by reading about your problem. For example, the Cleveland Clinic’s website has a great graphic depicting which organs may be causing abdominal pain. Type a list of your concerns but keep it focused, as, unfortunately, most physicians don’t have time to thoroughly address a long list of issues. Review your list with the medical assistant and ask them to scan it into your records.

7. Primary care providers may not consider a diagnosis they don’t often see. Requesting an ultrasound if the pain is severe or not improving may save your life. If the provider says that you don’t need it, you can get a self-funded ultrasound for less than $200 in many states. Take your concerns to the office manager or a director overseeing the practice.

8. Unfortunately, I don’t see a return to the times when doctors spent 30 minutes with a patient. Paying PCPs more for their time would quickly change the system, but it’s not going to happen. Medicine has morphed into big business with trillions of dollars spent each year. Finding a great provider may be a challenge but there are well-trained doctors, NPs and PAs out there who will listen to you. Word of mouth referrals are often the best. Reviews of physicians on hospital websites are not helpful in my experience, so check out independent sites when possible.

9. View your first couple of visits with a new practice as an interview and move on if it’s not a fit. Remember, you can always end a long-standing relationship with a practice. If you decide to divorce your provider, send a certified letter to the administrator of the practice explaining why you are leaving.

We physicians know the healthcare system is broken. Hospital executives are overpaid. Since PCPs are paid on average $180,000 versus the $500,000 an orthopedic surgeon makes, the best and brightest medical students often pursue highly paid specialty positions. Physicians are overbooked, overwhelmed, tired and burned out. Computerized medical records have made it worse. The end result is often poor patient outcomes. Since you can’t change the system, you have to learn how to navigate through its waves using some of the suggestions that I have made.

After my experience, I was certain that I wouldn’t survive a year but it’s now been over five years. My kidney function and anemia have improved. I am still dealing daily with my heart failure, restricting salt, resting for hours at a time and reducing my activities. I was able to resume golfing. Through my physicians’ support and the love and tender care of my wife and others, I have accepted what happened to me. It’s not what I had envisioned a decade ago, but I have a good quality of life. In the end, I survived, but I came too close to death that should have been easily prevented.

part 2