Please help with a reality check.
 

Went to a new endocrinologist (Dr. Jones) for diabetes eval. He tells me he treats osteoporosis too. I had had a bone density test done at the hospital (St. John’s) where he practices but the results weren’t back at the time I saw him. So he says to call back in a few weeks. In the meantime, another endocrinologist (osteoporosis specialist) at St. John’s I had consulted mails me the results and says all is normal.

So I call Dr. Jones for his thoughts on the results and his clerk says he “does not practice over the phone.” I said how is telling me what he thinks of the results “practicing?” She answers, “Well he’s giving you medical information isn’t he?” She ends by saying that she’ll have him call me if he needs to. No phone call the entire week.

I email him on May 15 with the same question…what does he think of the results (Remember, I only went to see him for a diabetes eval…he was the one who broached the bone density test.)

So far have not received any response. I know it’s too soon but my question is: since when does an m.d. not discuss test results w/ a patient over the phone? I had waited 4 months for an app’t with him. I would make another if that’s what it takes but has anyone ever been told an m.d. doesn’t “practice over the phone?” Am I being unreasonable? If not, do I just find another m.d.?

Antonia,
I certainly for one do not believe that discussing the results of a test he had ordered, over the phone is out of the ordinary. If it's too complicated or time consuming, then the office should tell you that you need to make a return visit and schedule you for another appt. Perhaps you could get the test results from the facility that ran the test. If not, I'd call back and ask if you are to make a return appt to discuss the test results. Looks like to me they are leaving you hanging with no answer.

Billye

Antonina: He certainly CAN discuss the results with you on the phone; doctors do this all the time. But why do you want him to? You've already been told by an endocrinologist that the results are normal and you have the results in your hand. I don't get it that you want him to call you about something you already know about. Am I missing something?

Doctors are banned by HIPPA law to reply to emails from patients. Emails are considered public, and so using them violates privacy law.

However, some people find it helpful to FAX a note to their doctor when they feel they are unable to get past the secretaries. You might fax a nicely worded, humble note, saying...I believe you received the results of my bone density; I don't want to take a lot of your time, but, if there isn't anything extraordinary that needs to be discussed in person, I'd really appreciate a phone call telling me the results. If there's something that requires treatment, please let me know.

That might work, if you need his input for some reason.

I'm not sure--
 

--from my knowledge of HIPAA, that e-mail is off limits.

Password protected e-mail systems on both ends certainly qualify as "private"; at least as private as phone conversations, given current eavesdropping technology. They're certainly more private than faxes, and I have certainly had doctors who will fax lab resutls to a patient with the patient's consent. (I have also set up a fax to e-mail number through E-fax for that reason.) And, there are doctors who communicate by e-mail. Among those that don't, I think they are just uncomfortable with the technology--or, more likely, especially in your case, they're just trying to get you to come in for another office visit so they can bill you, and insurance, for it. THAT'S my suspicion when some secretary says the doctor "doesn't practice over the phone".

There are a lot of things about HIPAA that doctors and their staff tend to believe that are patently false. For instance, I've been told by some medical office staff that the doctor cannot send me or give me a lab result without discussing it with me first, and that this is a HIPAA regulation. It absolutely isn't--and I tell them it's simply their office regulation, and to read their HIPAA material better (and I always politely offer to send them some).

I like to start them with this article:

http://www.nytimes.com/2007/07/03/he...5NKiKQSE3tX6cg

I will even send them the entire original act:

http://aspe.hhs.gov/admnsimp/pl104191.htm

The point is, HIPAA, in sum, is designed to prevent discussions or revelations of individual medical info WITHOUT THE PATIENT'S CONSENT. If the patient consents, this flow of info is not to be diverted. It's why I often given a new doctor a letter stating that s/he is allowed to discuss my medical condition with other docs I have, members of my family, and even a few friends whose judgment I trust in the event I'm incapacitated.

The other stuff that is claimed in the name of the statute is bogus (as the article describes), and has already led to some troublesome lawsuits--exactly the opposite of the original intention.

I suspect your doctor's office is just being hidebound (and greedy).

Thanks for your responses Silverlady and Glenntaj.

Just a clarification of why I might want Dr. Jones to give me his opinion on the test even though I was told it was “normal.” The m.d. who originally ordered the test while very nice and very willing to speak with me by phone strikes me as less thorough and less “engaged” than Dr. Jones and I would have liked to keep seeing Jones. Moreover, Jones seemed to want me to switch to his care and was very interested in the outcome of the bone scan.

As far as there being a greed factor involved, I doubt it. Jones has a thriving practice (I had to wait 4 months for an app’t.) I don't know if I could get another appointment without having a 2 or 3 month wait.

I think faxing might have worked better. I wish I had thought of that. The other side of this is that I might seem like a stalker if I now fax him with the same request!!

Re: HIPPA....if I'm the person (patient) emailing, isn't that granting the md implicit consent to release the info to me? I like the idea of presenting a letter which grants specific consent. It cuts out all the paperwork involved when you want other docs to get your medical records, etc. Thanks for the suggestion Glenntaj.

My neuro has emailed me Rx info, and my titration schedule to replace Neurontin w/Lyrica.
My PCP also has responded to my emails (but doesn't like me to email her, unless absolutely necessary, and I cannot get thru the group practice office staff.)
Bob B

Antonina:

Regarding faxing a doctor's office (especially if it's a BIG practice). I have done this. And the doctor never got the faxes. It doesn't go to him immediately by the way.

Fax machines are usually in some back room (absolutely every one of my doctors, have their fax machines in a back room). The staff has to go and check ALL THE FAXES, and sort them out, and find which fax goes to which doctor.

Now if you have one doctor in the office with one staff person, well, that's a whole easy thing going on there.

But, let's take for example, the orthopedic department of Beth Israel (where we went last week).

We are talking Many doctors, many various office cubicles, many staff members, many department heads, many this and many that. And if you have one fax number, well FORGET about the doctor ever getting the fax. He MIGHT, and then again, HE MIGHT NOT!!!

And calling to speak to a doctor (very rare to get them on the phone initially). I got lucky the other day when I phoned Alan's doctor. AND THAT'S A BUSY OFFICE, BELIEVE ME.

In Alan's primary docs office, there are two doctors, with about 10 girls in the reception area, doing different stuff. Like HMO calls, billing, stuff, answering questions, taking blood. I would never fax that office because he would never get the fax. I've tried this, I tried calling after I faxed and I was met with "you faxed us?? when did you do that, the fax machine is at the other end of the office".

Now one would think. "this is 2008", why isn't their fax machine right up there next to the phone, in the reception area??

Because the fax machine would be going all day long, and driving everybody crazy, (but that's just my train of thought).

And the only doctors I know that does emailing is my dentist, and Alan's ortho guy. Alan's ortho guy has an email address but I rarely correspond this way. You have no idea how much spam that people get in their emails. That's why doctors today really don't like to do emails. They have to either sit down at the computer, and sort out their emails, or they have to have their secretaries do this for them. Not good time management.

When I take a blood test, I am told to call in 3 days. Then they will either fax me the results, or I can go and pick it up. They also say "if there is an irregularity, that's the only time the doctor will call you back and speak to you about the results". "But if you want to make an appointment and come in and go over your results, well that's fine".

So the message I'm getting on this is "we'll call you only if we find something wrong with your blood tests".

But the nonsense that you were told about "He can't discuss blood tests results with you over the phone", well, that's just plain bull *****.

I do not understand why you were told this.

I have always spoken about blood tests over the phone... ALWAYS.

So I wish you well on your journey of result gathering.

Best of luck.

Melody

Hippa is very misunderstood by doctors offices and hospitals. I have been told that i would have to sign a release to authorize myself to receive copies of my tests at a number of doctors offices. In 2003 when the law had first taken effect i went myself to the emergency room of North Shore Hospital for chronic asthma for 5 weeks 24/7. They admitted me and i asked them to call my wife and tell her and they said they couldnt do that under Hippa. I said i'll sign something , they still said no so i just grabbed the phone off the desk and called myself.

Melody, you've captured the faxing mish mash very well. I've had all the back & forth you've experienced. The diabetes md is a solo practitioner so I don't think the fax would be as likely to get lost as it would in a group practice. I think, however, that the rude office jerks would somehow "misplace" it. A little paranoia is creeping into this whole situation.

Nide, you are truly lucky. The only md who ever responded to my email is the friend of a friend and so would maybe ignore it if not for fear of pissing off our mutual friend.

HIPPA looks like it's a nightmare to understand. Hey Joe, you were smart to get on the phone yourself. Luckily, you were not out of it and unable to take charge.

never
 

NEVER underestimate the passive aggressive helpers in a doctor's office!

My husband audits them...they are very underpaid and in return their egos
grow in a compensatory fashion.

My Doctor's office has some doozies! :yikes:

Thanks Mrs. D for validating what I thought was mostly my problem. The two who work for Dr. J are undereducated and probably underpaid. It's pretty clear that they regard patients as necessary evils. And because they are not entirely answerable to the doctor (I think the hospital pays their salaries) they can pretty much run the show as they want.

What kind of auditing does your husband do of support staff? Does it evaluate their performance/skills, etc.?

Doc's Staffs
 

Antonia, I've had some "interesting" experiences with docs and staff and confidentialiality issue - and have found pretty much that the docs who treat their staffs the best, the staff in turn treat patients better (as in any job really)... if you see constant turnover in an office - its a sure sign something is really wrong... if you hear a lot of complaining - it usually starts at the top - happy employees are loyal but not usually nasty, instead they strive to do the most they can to help their doc out by getting info for them, etc... (I try to listen very carefully to staff when in the office and if its a new doc prior to even making an appt, ask what type of person the doc is - rushed, how much time will I get, etc.) (another good indicator of good doc and loyal staff - ask the staff how long they have been working for the doc - the longer the better - that means they are happy employees and a positive environment).


Everyone has a bad day occasionally of course - and need to follow policy - but if they are consistently rude - theres a reason.... there was no need to make a nasty remark to you - instead if it is policy to make a return visit - they should have said so.... also, I've had docs I've both communicated with by email and fax.... and others by phone - if they dont give their e's obviously they dont want to hear from you! (90% in my area do not) I've sent faxes - only to be told by docs to please call them instead - they dont have time to wade through paperwork - instead the office staff can ask them questions directly and either they or the doc call back..... (and they do follow through)..... As far as HIPAA - yes, it seems that sometimes it is up to open translation.... I cannot get copies in my area at all of any test results (of any kind) except from a doctor - not a test center.... on the other hand - I find sometimes docs are very loose with your personal health info and share it with those they should not - I now specify in my chart as a new patient the only people that my medical status may be discussed with. (of course docs do discuss patients with each other, inappropiratey or not - and we cant stop them on that)!

Want to know what I've noticed. (Now this doesn't happen in ALL offices, but it happens enough).

It's the young ones. The one's who are there for the summer, or that their mother told them "get a job",

The ones who are polishing their nails and when you approach them with a smile on your face and you ask a question such as "What is your fax number, or do you do email"?? They look at you as if you have lost your mind, or they give a big SIGH!!! like they are talking to a neanderthal

It really bugs me, the way the young ones treat the older patients. No respect, no compassion, and definitely no patience.

Don't believe me?? (and this happens ALL THE TIME IN BANKS).

The next time you go to the bank and you are on line, watch how some of the young tellers (it's probably their first job), treat the elderly people on line.

I encountered this and one day I acted upon what I had just witnessed.

There was this little old lady at the teller window. She had just asked a simple question and the young girl went completely off on her. The elderly lady just stood there not knowing what to do. The rudeness just blew me away. When she finished her transaction, and walked away, I was next at the teller window. I was greeted with a big smile and she actually looked at the lady leaving the window and she rolled her eyes, as if to say "look what we have to deal with". (I was about 40 at the time).

I looked at her and said "do you have any idea how rude you were to that woman?, why on earth do you think you have the right to diss ANYONE, let alone an elderly woman. She might have just lost her husband, do you even EVER THINK ABOUT WHAT COMES OUT OF YOUR MOUTH??'

She just looked at me, (she really had no clue what she had done, or the severity of it). I politely leaned over and said "EVERYBODY DESERVES RESPECT, THAT IS YOUR JOB". She apologized. She was chastened.

Best thing I ever did.

very good Melody, i can just picture it. Ha ha. Many people have no shame anymore.

I think they are queen bees in the making!
 

I have had to deal with young women as techs myself.

The more they are temperamental, the more conflicts they have with their own mothers, the more they cannot see past their own nose.

There is a type...who once I train them on the computer--- they think they have become THE PHARMACIST.... it is a power thing. One manager where I used to work, called it The Computer Orga$m. We used to laugh at that one.
( I hope I can say that here). This type will stand at the computer and refuse to wait on customers or answer the phone. If you try to correct you get the massive EYE ROLLS! One gal did that to me so much over an hour I had to threaten to send her HOME. Most of the time I was temping there so I do not have managerial power. It can be very frustrating.

And just so you understand, I did have one young man who was afflicted with this problem as well. I caught him giving advice on the phone, and telling a woman he would NOT fill her RX (it was refillable). When I called him on that --his response was "I don't like her". Well, I called the district manager and reported him (this young man also had cell phone-itis which was distruptive) and he was fired. (I didn't get to do it however). This young man also made a crack loudly about an AIDS patient, so his goose was cooked very quickly. Typically the girls are not quite this bad, just massively irritating.

I've had a few older ones too, so I don't think it is always age related. It appears to be narcisisstically related and entitlement issues. It is very related to how they behave at home, IMO.

Employees
 

Yes, slightly O/T - but gotta agree - in many cases there is a real entitlement attitutde towards what is expected now in the workplace - lots of benes for little work.... those who are going to succeed in the future are easy to spot - they try harder - and project their wish to succeed in all they do - and they will stand out and move ahead.....

As for tellers - I guess I've had good luck with them - but I was a min wage teller at one point for a short time while in college... short time cause was robbed at gun point twice and being paid practically nothing was sure not worth it! (we didnt have windows to proctect us back in those days from the "crazies" - and got the heck out of that job to literally save my own life....) I also have some sympathy for them!

Letting someone know they are being rude when they are in a nice way - a good thing! There are so many jobs now also where there is absolutley NO accoutability it feeds this notion - dealing with phone service people who are not required to give out id's etc... they can do whatever they want! I have a drug plan now that they know their supervisors can listen in whenver they want - and I get great service - amazing diff from the last group!

Just had to make one final comment.

When I was in my early 20's, I was an executive secretary. I had to train a woman who was in her 50's. I thought she was ancient, now how stupid was I??

Maybe it has to do with my age?? I don't know. I also NEVER got along with my mother. So maybe that played a part.

I was impatient, rude, and I also, (along with the others), made fun of her.

I could kick myself but that would have no bearing on my behavior way back then.

All I can tell you is that, as I matured, and as I watched MY FATHER deal with people, I myself learned how to treat others.

My mother was rude, overbearing (for example, when she was selling her house in Florida, a couple in their 70's came to look at it, and my mother turned to the lady and said: "why on earth do you want to buy this house, you are old??" I kid you not, she said this.

So this is the person who raised me.

Thankfully, THIS IS NOT HOW I RAISED MY SON, I can assure you of that.

So I was just remembering how thoughtless I was at times, when I was 21 or so.

Thankfully, I grew into my skin, I grew into my brains, and I stopped doing that kind of behavior.

I only wish that someone would have pulled me aside when I was 20 and put me in my place. I woudn't have wasted so much time being rude and thoughtless.

No one called me on it. We were all young at the time.

Sorry to go off topic, but I just had to say this.

I have a conversation about today’s youth periodically with a former colleague who teaches at the City University of NY. The gist of our talks usually results in our unfavorably comparing today’s college kids with those of our youth. I think it’s what the older generation does. We look back through rose colored glasses and see only the positive. But I recall all the times I was late with term papers, cut classes, didn’t read assigned texts, etc. And let’s not even discuss my work ethic. I didn’t really “get it” until I was in my mid twenties and out in the world where one’s performance is judged by different standards.

I’ve found that medical support staff is mostly comprised of twenty somethings with poor communication skills and a pretty crappy work ethic. They’re mostly marking time. I think if a doctor is cutting corners and doesn’t hire a PA or a nurse to field patients’ questions, you are at the mercy of nail polishers, text messagers, cell phoners, etal. Maybe that’s a reason to look elsewhere. NYC has tons of mds.

Melody, I too cringe when I recall how unfeeling I was towards the elderly when I was a 25 year old hotshot. I remember being so annoyed when older shoppers in supermarkets who couldn’t make out the prices had “the nerve to ask me to read it for them.” No one ever taught me about having some compassion for those with failing vision, poor hearing, etc. The only lessons I learned were from achieving some maturity and then having those self same disabilities.

But the bottom line: if Dr. J’s support staff are so clueless, shouldn’t I try to find someone whose gatekeepers may be slackers but at least are civil. And maybe their incivility runs from the top down.

Mrs. D, I think these two airheads are indeed on a power trip. They have to get their jollies somewhere; why not get them at the expense of sick people?

I think it's related to how they were raised...or not, as the case may be. None of my kids would *ever* be rude to anyone, such as has been described in some of these posts. I would never act that way towards anyone no matter who they were or their age. I taught my kids the same things. Whatever happened to teaching the golden rule? You get back, twofold, whatever it is you send out, positive and negative.