How to Avoid Some of the Common Errors that Occur in Outpatient Care

If you read my last post, you’ll know I talked about some of the common mistakes made in outpatient settings, to include doctor’s offices and any type of clinic; errors that can truly make you sick or cause an injury. While most healthcare providers strive to provide excellent care to everyone they see; unfortunately some do not. 

What can you do to prevent medical errors from happening to you? While no one can control everything, and some things can be out of our control, there are some steps you can take to reduce your risk of being on the receiving-end of a medical mistake.

There are also red flags you can keep your eyes open for – telltale signs of a dysfunctional provider, staff and medical team, a poorly run practice, and staff members who don’t care about you or the care they provide.

As in my last post: The situations below are all ones that I have either experienced personally as a patient, or have witnessed when I've accompanied a family member or friend to an appointment...I wish these were not real events and situations, but sadly, they are.

So...buyer and patient beware, and read on...

Photo credit:

Public Domain Photo by the CDC/Debora Cartagena

First the red flags and steps to take when you see them:

Here are some signs that should cause you to reconsider if you want to continue receiving services at any type of doctor’s office, clinic, and medical practice of any kind.

Rushing

What is rushing? A doctor or other provider who runs towards the door and is half way out the door before you’ve had a chance to ask even one question about your new diagnosis, a medication, or his or her synopsis/opinion of your condition.

Providers who rush can and DO make mistakes such as making the wrong diagnosis, giving the wrong drug or dose, or not recommending the appropriate tests, or follow-up visits for the real problem, or for a condition that is in evolution but was missed – and one that needs close monitoring.

Rushed providers may not (and sometimes do not) take the time to tell patients the risks and benefits of a recommended surgery, procedure, or medication. 

High volume practices of any type that stuff patients in by horrific, continuous overbooking practices, should give you cause to pause, step back, and think about the quality of care your provider is delivering to you.

If you see a provider that's always rushed, and you feel comfortable broaching the subject with him or her, discuss the fact that this makes you very concerned and uncomfortable about the quality of care you're receiving. If you're not comfy bringing the topic up and not happy with your care...it may be time to move on. Find another provider. Most likely things will not change, but it may be worth a try if you feel the need to do so.

Stressed Out Staff

If most of the staff seems high strung, rushed, and don’t appear to have the ability to connect with you, your family or other patients, these can be signs of poor working conditions, chronic short staffing, managers that make poor choices and hire the wrong staff, and poor management of the practice and clinic overall. 

Multiple studies have shown that tense, stressed medical staff make more mistakes.

If you witness staff tension, ask to speak with the supervisor or manager. Discuss your concerns with them. If you feel your concerns are not being heard, consider changing providers.

Rudeness

Rudeness can manifest in many ways such as; terse responses from staff to your questions, outright rude behavior directed towards you or a loved one, a condescending attitude directed at you from any staff member, staff that are openly fighting between themselves, and witnessed bullying of one staff member towards another.

Any type of rude behavior can translate into the practice and providers not valuing your business, your health, and your welfare. Who wants to be treated rudely at any time, let alone when you’re sick, injured and worried about your health. Providing the best care to you and the other patients should be the focus of all staff members' attention – and nothing else.

Rude treatment by staff is also a topic you'll want to bring up with the physician/provider in charge, or the nurse or practice manager. 

What additional steps can you take to assure you’re receiving accurate care?

Medications

If you're placed in an exam room and find any type of medication left unattended such as, a filled syringe or cup of oral medications, that spells trouble. This is sloppy, dangerous and negligent. If in fact, this happens to be a medication intended for you, you can refuse it and ask to see your medication being drawn up, or oral medication pulled from its package. 

If you’re given medication samples, you’ll want to check the expiration dates, name of the drug and the dose, to make sure you’re being given the same drug you were told about during your exam and visit.

If you’re picking up any type of prescription from a pharmacy, verify the name of the drug, the dose, and the dosing instructions. Also, check the label to make sure that the pills inside of the bottle, match the description of the drug listed on the label. Example: The label says a round blue tablet with the letters AB on it, and inside your bottle you have an oblong white tablet with different letters or numbers.

If there is any mismatch or if you have any concern there is a problem – don’t take the medication and immediately reach out to your pharmacist and, or prescribing provider to alert them to the problem and get the correct medication.

Labs and Diagnostic Tests

Follow up calls on lab or other tests that you need to take, or need the results of: If you’ve been told you need lab or diagnostic test, and no one has contacted you to schedule the test, or you were not given an order for it, call your doctor’s office to follow up.

If you had tests already and you never received the results, call your doctor’s office and tell them you need your test results so you can be scheduled for a follow-up visit to get your results. 

Tests results can many times result in a new medication being prescribed, a medication that can now be deprescribed (discontinued), a switch to a different drug, or the dose of the same medication lowered or raised. These are some examples of why it’s so important to receive your results. 

Also you may have a new medical diagnosis that you need to know about as a result of the tests you had done. On the flipside, you may no longer have a condition that you thought you had, or were told you once had, due to the findings of your latest test results. 

Last, follow your gut and your heart!! 

If you feel you’ve seen a doctor or other provider who sped through your exam and visit at lightning speed or had their hands on the door knob while speaking with you, have been the recipient of rude behavior, have been given the wrong diagnosis, was prescribed the wrong medication, experienced billing errors, or have any other concerns about the care you're receiving, you may want to seriously consider seeing another provider. 

Maintaining a proactive role in your health and care, and educating yourself from reputable sources for medical information regarding your conditions and medications, can help you stay on a path to better health and safe care. 

Poorly Managed Medical Offices and their Staff Can Make You Sick: Common Errors in Outpatient Care

When most people think of medical mistakes, their minds immediately jump to dramatic life-threatening errors that can occur from emergency care by first responders out in the field, in emergency rooms, or on hospital floors. While errors can and do occur in any patient care environment, staff errors that happen in private medical offices and clinics can occur on a frequent basis, and sometimes continue for a long time with no supervision, correction or resolution by the physician in charge. And if there is not a nurse manager to oversee patient care and operations, many times the doctor in charge is not even aware that problems exist.

Sometimes mistakes are made by unlicensed personnel, while other times it's the doctor or another licensed provider. While to error is human as the famous quote goes, it's how errors are handled and resolved that makes the difference when caring for patients. If no attempt is made to correct errors that affected you or other patients - it's a red flag warning that you may want to consider changing healthcare providers.

While many outpatient providers consist of hard-working, dedicated staff that truly care about providing professional, timely, safe patient care and friendly services, sadly…some do not. 

Errors in outpatient care can and do severely impact patients’ lives in profound and negative ways, just as mistakes at a hospital or at the scene of a car accident can. From billing errors, to office procedural errors, to errors with hands-on patient care, all can make life miserable for you and other patients. If you were not in an ill state already, dealing with the fallout of others' mistakes, can truly make you sick. Just like the delicate flowers in the photo below, care must be taken to prevent harm to all patients, and especially those who are experiencing acute medical problems, are in delicate conditions, and difficult situations.

Delicate spring flowers by Carole Jakucs. May, 2017. Image subject to copyright.

Many times, the perpetrators of outpatient/ambulatory care errors continue their negligence and, or, sloppy care without appropriate intervention from management or the physician, due to a lack of having licensed staff (RNs or LVNs) to provide care and serve as a staff resource to supervise unlicensed staff, a lack of time for the physician to maintain proper oversight of unlicensed staff, or simply due to a laissez faire attitude on the part of the doctor(s), practice manager, and, or, clinic management.

Below are some common errors and unethical practices that occur in private medical offices, clinics, urgent care centers, dental offices, and surgery centers.

I've personally witnessed the errors below either as a patient, while accompanying loved ones and friends to appointments, or in my professional capacity as a registered nurse while working to help patients who were on the receiving end of irresponsible care.

Breaches of Patient Confidentiality by all Staff:

• Paper charts or test/lab results being left on counters and desktops for all to see.

• Electronic medical records: Patient charts not being exited and the staff member not logging off and out of the system when they leave their desk or the patient’s exam room; patient charts left up on the screen for anyone to see.

Billing Errors:

• Negligent billing staff that submits overcharges to patients’ insurance companies for services not received, or sending duplicate bills (charges for the same date of service twice or more).

• Negligent billing staff that tells patients’ insurance companies they have another insurance provider (in addition to them) when in fact, they do not. This causes an alert in the insurance company’s data base system to place this person’s medical insurance on hold, as the company then seeks out information on who the other company is – when in fact, the patient has no other insurance. This causes a delay in all subsequent bills being paid, requires patients to make multiple phone calls to straighten out the problem with their insurance company, and alert the doctor’s billing staff to their mistake.

Calling Wrong Numbers or Not Calling at All:

• Negligent office staff that call the wrong number, leave a phone message on the wrong voicemail of with someone other than the patient, or worse yet, saying and charting that they spoke to a patient when they did not - engaging in outright lies.These phone calls can pertain important issues such as, but not limited to, confirming patients’ future appointments, advising patients they need a follow up visit with the physician, or a new diagnostic test is needed (MRI, lab test, etc.)

Unlicensed staff practicing beyond the scope of their training and the law, such as when:

• When unlicensed staff are trained to conduct invasive procedures on patients that are beyond the scope of their practice, or dispense medications that are not properly labeled according the state medical board’s requirements.

• Unlicensed staff such as medical office workers and medical assistants providing telephone triage or in-person triage, dispensing medical or nursing advice without the license, education, or training to do so. This is not legal and just plain wrong.

Poor Practices:

• Medical offices and clinics that have no process in place for double checks to be done for staff for fellow staffers, prior to injectable medications being given to patients.

• Medications left unattended in exam rooms.

• Inaccurate blood pressure readings - and usually they're false highs. This can lead to a mistaken diagnosis of high blood pressure (hypertension/HTN) and prescriptions you don't need, all due to the fact that the person tasked with taking your blood pressure is doing it WRONG.

Problems with Prescribed Medications: 

• Concerns about adverse drug reactions (side effects) from a medication you've been prescribed are ignored by the prescriber (MD, PA, NP).

• The prescribing of medications that cause known side effects such as liver damage, kidney damage, muscle damage, B-12 deficiency, and magnesium deficiency, to name a few; and no follow up lab work is done to monitor the patient for the development of these complications. Some common drug culprits are proton pump inhibitors, statins, oral antidiabetics, and blood pressure medications. 

• The prescribing of medications YOU DON'T NEED or, the prescribing of too high a dose, or for too long of a time period. 

Other Lapses in Care:

• Staff that call in (or fax) the wrong prescription drug to a pharmacy for a patient, and, or the wrong dose. 

• When physicians refer to their assistants as “nurses” when they are not licensed nurses such as an RN or LVN. Thus, patients think they are speaking to a licensed nurse such as, an RN or LVN, and if they are not, it's misleading. *In some states, is illegal to refer to someone as a “nurse” when they are not.

• Medical offices and urgent care centers that don't have licensed RNs or LVNs on staff. While it may not be financially feasible for every medical practice and clinic to have licensed staff present, this can be problematic, as unless the physician(s) in that practice has a tremendous amount of time to supervise their staff, (which most do not), staff errors and bad practices can go on forever, unchecked by anyone. *Even licensed staff members need a resource person, peer consultation, peer-review, and a supervisor to help maintain standards and high-quality patient care.

• Clinics, offices, or ambulatory surgery centers that could benefit from an outside resource reviewing the quality of the patient care they provide, policies, and procedures, but have not spent the time or resources to do so. One example of a commitment to quality is when organizations seek accreditation from a third-party such as a nationally recognized accreditation organization.

• When concerns about the care you received, a problem you've encountered with a staff member or, a mistake you've been dealt due to an office procedure are ignored; your request to speak with the manager goes nowhere, no one calls you back, no one take responsibility for the error, no one apologizes for the incident, and, or you are not given a chance to speak a supervisor (or there is no designated supervisor) who has the power to resolve the situation for you and ensure that it won't happen again.

Coming soon: How patients can avoid some of the common errors that occur in outpatient care, and inaccurate blood pressure readings.

Seven Tips for a Healthier Heart

American Heart Month just wrapped up in the U.S. And with spring around the corner with its promise of new life with flowers abloom, it's a good time to think about your life with healthy habits that can lower your risk of heart disease. Heart healthy habits are good for your whole body (and brain) too.

Boston Common by Carole Jakucs, 2016. Image subject to copyright.

Increase your activity – Exercise 30 minutes daily to help maintain weight and improve overall fitness (check with your doctor before you start) which will help reduce your risk for cardiovascular disease and type 2 diabetes.

Eat a healthier diet – Reduce or cut down on junk foods (pastries, chips, candies, sodas and alcohol) and bad fats such as saturated fats (red meat and full fat dairy) and hydrogenated oils (in junk foods and even some so-called healthy snacks and foods). Increase your intake of fresh vegetables and fruits, lean proteins and whole grains - to help maintain overall health by getting a variety of vitamins and minerals in your diet.

If you smoke – QUIT! Smoking damages the cardiovascular system and causes a multitude of health problems and illnesses.

De-Stress – Look for ways to decrease stress in your life as ongoing stress can raise your risk for cardiovascular disease.

Maintain a healthy weight – Find out what your healthy weight is for your height and body frame and work to stay within that range. Excess weight increases the risk of cardiovascular disease, type 2 diabetes and some cancers too.

Monitor your serum (blood) levels of cholesterol and triglycerides (with your healthcare provider) with a goal of achieving readings in the heart healthy target levels.

Enjoy life! Life can get busy with work and tasks – make the time to do things that make you happy such as being with cherished family and friends and pursuing hobbies you love.