Q. As a physician, why are you saying we should distrust our doctors?
I am not advocating distrust, just caution. Think of your Medical Record as if it were a contract with your physicians. Your responsibility is to make sure there are no errors of fact, logic, procedure, or credentialing before you 'sign off' on it.
Q. Why can't we just talk with our doctors, and ask more questions? Wouldn't that prevent errors before they occur?
You can't talk anybody, even a doctor, out of making cognitive errors, such as leaping to conclusions or wishful thinking. You can't watch over a senior doctor's shoulder to make sure the student doctor's report is read critically before it gets into your chart. You can't persuade doctors to think logically and to write without ambiguity. You can't insist beforehand that they produce a data report (such as an x-ray reading) that fulfills the Guidelines of their professional association. You can't assign yourself to the most appropriate specialist. It may well be a matter of luck -- who's on call the day you're admitted or evaluated, and who is covered by your Health Plan Network.
Q. You don't talk at all about why doctors make mistakes, just about what kinds of mistakes they make. Why is that?
Because it doesn't help to know why an error is made. No matter why it is made, once a mistake gets into a record it tends to be accepted as fact, unless an outside party (YOU) corrects it and sees that it doesn't creep back in again.
Q. But what if you haven't had any medical training?
You don't need any. Just clear away the medical terms and then look at the plain English structure. You can spot scary unanswered questions, 'pretend' rather than real diagnoses, reports that are incomplete or ambiguous, and illogical thinking. You can make sure a student doctor's report has been carefully read and corrected, and that your specialists have the appropriate Board Certification to treat your particular condition.
Q. Do I need to be a computer expert? Do you give us lists of websites?
No. The whole point is for you to become an expert on your own Medical Record, not an expert in tracking down sources of information.
Q. Does everybody have to go to all this work of checking?
Again, think of your Medical Record as a contract with your physicians. Would you sign a contract for any other kind of work without reviewing both it and the credentials of your professional?
Q. Is there anybody who absolutely ought to get right on this and do it promptly?
In my view, these are the high risk situations:
- A serious illness.
- An uncertain diagnosis, especially if one of the possibilities is scary.
- Symptoms that persist, worsen, or recur despite an 'innocent' diagnosis.
- A diagnosis that doesn't make sense -- one that is rare in your age group, gender, race, exposure to toxins, etc.
- More than three physicians are involved, including student doctors and doctors who interpret studies, such as x-rays. Four different doctors means a potential for 120 possible combinations of communication among them and with you. Remember the party game, 'Telephone?' As the whispered word goes round the table, it turns from 'Cabbage' to 'Garbage.'
- An uncomfortable relationship with one or more of your physicians.
Q. And I have to worry about staying safe in the hospital, too?
Absolutely. We are in the midst of a nursing shortage, and it's going to get worse. You have to be prepared to fill in care gaps. See, for example, the first excerpt from the book, on this website.
Q. And on top of all this, you say that our Health Care Plans are manipulating us?
Health Care Plans tell you to 'First choose a Primary Care Physician from our list. They present this choice as a perk or privilege. Once you do so, you are automatically restricted to the referrals and services of the particular Network in which that doctor is embedded. These restrictions override the Plan Contract itself. For instance, your Plan may say you're entitled to 24-hour home nursing care, say, or speech therapy for your four year old; but your doctor's Network may simply deny that service.
Q. How do you feel about your profession after your experiences, and after writing this book?
Proud and worried. Proud because as a Pediatrician, I have been lucky to work with doctors who are both transparent -- encouraging parents to question and contribute; and accountable -- explaining our reasoning, discussing options, open to specialist referrals. We are lucky to have a patient population that is educated and assertive. That's how I know how much both physicians and patients (or their caregivers) benefit from full participation in constructing the contract of the medical record.
Worried because the governance of the medical profession seems to me less transparent than is wholesome. We should encourage patients to check their medical records; make Peer Review open to patients and their helpers; and try to avoid medical jargon whenever possible.
We also need to be more accountable as a profession. The recent movement to encourage doctors to apologize for their errors is certainly a step in the right direction. We should welcome software that assists diagnostic accuracy, such as Isabelle Healthcare. And we should embrace software that serves a watchdog function, making sure reports are complete before they can be signed off -- and billed for.