Two conversations in the past few weeks make me realize what a big problem this is. And the weight -- the responsibility and the negative outcomes -- rests on the patient, no matter how the scenario shakes out.
First conversation:
My friend Rachel took the day off to accompany her husband for a day surgery he needed. Her husband is diabetic and overweight and had been warned by the surgeon that his blood sugar would be tested prior to the surgery. If it was over a certain number, then the surgery could not be performed.
As you might guess -- her husband's blood sugar measurement wasn't even close. It was beyond too high - it was way too high. Rachel didn't know until they arrived at the surgery center that any warnings about her husband's blood sugar had been made. She knew her husband had not been careful about what he had eaten, nor had he taken his medication the way he was supposed to. She's angry, worried and upset.And her husband must make new arrangements for his surgery. Both will have to take yet another day off from work, etc etc.
Second conversation:
.... took place with a physician - I'll call him Dr. Brown. Dr. Brown is an ophthalmologist who is in demand! He performs eye surgeries at a day surgery center not unlike the one Rachel took her husband to, and like Rachel's husband experienced, he must often provide warnings to his patients and rules for them to follow before their surgeries.
Dr. Browns' story was about a patient he had been ready to operate on earlier that day who had driven in from 80 miles north, and who was sent home not having had the surgery -- because the patient had failed to stop taking his blood thinning meds for the prescribed week prior to his surgery. If his blood was too thin there was a possibility it would not clot correctly during the surgery which could lead to many bad consequences. A real safety problem.
Dr. Brown's complaint was that he provides those warnings weeks before the surgeries -- in person during the patient's appointment, and in writing with a list of other pre-surgical instructions. Yet Dr. Brown must refuse surgery for several patients per week because they have not followed their pre-surgical instructions to stop taking meds.
In both cases:
The patients and loved ones/caregivers are frustrated, probably angry, and the patients haven't gotten the treatment they need.
The practitioner is frustrated and probably angry that the time allotted for that patient will go unused, meaning they won't be paid for the work AND that the patient must be rescheduled AND they have lost an opportunity to be paid for that time. I know I'd be upset.
The solution?
Not easy, for sure. One of the main complaints doctors have is that patients don't comply (also termed "adhere") to instructions. For their part, they believe they have been clear in their instructions (maybe they have, maybe they haven't) and do not understand why a patient doesn't follow those instructions. My only suggestion to Dr. Brown was that he assign someone to make phone calls at the appropriate time to patients who need this type of instruction. Calling a patient a week before his surgery to remind him to stop taking his cumadin costs much less than having an empty space in his surgery day.
From patients' perspectives, either we knowingly don't follow instructions, or we forget. Whose responsibility is it to be sure we follow through? It's OURS! Clearly there are times when we can't adhere for one reason or another. If we can't, it's better to phone the doctor ahead, and reschedule.
But there are just as many times we don't adhere -- not because we can't, but because we forget or we intentionally choose not to.
The bottom line is that the responsibility lies with us, the patients. If we are given instructions by our doctors for any reason, and it's something we'll need to remember at a future date, then we must put a reminder on our calendars, or call the doctor's office a week before a scheduled surgery... whatever it takes. If compliance will cause a problem, then it's up to us to let the doctor know and figure out the alternative.
Smart patients don't have unrealistic expectations -- as if we can just ignore instructions and they will go away. And we don't expect our doctors to babysit us. Pre-surgical instructions are made for our safety. Doctors can't keep us safe if we are unwilling to hold up our end of the deal, too.
- Learn more about compliance.
- Learn more about doctor's complaints about patients.
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Trisha,
I am very pleased with this article. I am a same day surgery nurse and you can not believe what we go through to get information to patients about going off of blood thinners, not eating before surgery etc…
First of all, (and I have to admit that some doctors are NOT good at giving their patients CLEAR instructions), the surgeon tells the patient at their office visit. Then, the patient is almost always sent home with a packet of information including what to do about coumadin, diabetic medications, high blood pressure meds etc…, then, we call the patient the day BEFORE surgery to make sure that they have been compliant with their meds, and that they know when to stop eating and drinking.
Despite all of this I still catch patients getting a drink out of the fountain in the lobby (their surgery has to be canceled), I still have patients come in saying that they took their daily aspirin that morning. I still have diabetic patients come in who have been non-compliant. And, I would add to your article that this isn’t just a lose/lose situation for the patient and the surgeon but for every other patient on the surgery schedule that day as we have to adjust their times to accommodate canceled or postponed procedures.
Thanks for getting the word out,
Kristin
ent.about.com
Even more scary is when the person that asnwers the phone at the doctor’s office tells the patient who is on seziure medication, diabetic medication, blood pressure medication etc. not to take their meds. the day of surgery! This person does not even open a chart – it is just their “standard” procedure.