Calling Dr. Stupid, come in Dr. Stupid...

[Harpoon]

I'm just gonna vent a little....


So I've been trying to work it out so I can get my INR tested at my primary care doctor's office with a fingerstick instead of having to get to a blood draw clinic and wait in line and hope I can get drawn before they close...

Today I get a call from my cardiologist. My PCP needs a little documentation regarding my past history with INR, where levels have been in previous tests, dosage changes, etc. and they sent my card a request to get that information. My cardiologist calls me and asks if he really needs to send all of that, it's a big file (20 pages or more) and they should have all of the info anyways because my PCP doc gets a copy of the report every time I have my INR checked.

Oh yeah, that's right... Silly me.


So I call the PCP office again.


They've been throwing out the reports.





I remember a converation with my PCP over the reports, he asked why he was getting them and I said because my cardiologist wanted him to have them and because I had him (my PCP) write an order once when the previous one had run out on me ("standing" orders are only good for 6 months I guess)

Apparently in his confusion, he just told the nurse (or whoever was recieving the reports to file in my chart) to just pitch 'em.

My PCP's a really good guy. He's always on top of things, except for this one time, and it kinda sucks because I may have to stop seeing him in a month or so (he's moving to another office that's an hour drive for me to get to)


Oh well...

My card is sending out the stuff the PCP office needs now....

Done venting.

 

[Nancy]

I don't know if this might shed some light but this is what happens with Joe.

He has several standing orders at the bloodlab, one for protime which is monitored by his Internist, one for metabolic panel for his Pulmonologist which is for the drug Tracleer and also one for a metabolic panel for his Cardiologist which is used when he has CHF. They are all written separately by each doctor. Sometimes he gets the protime and the metabolic panel done at the same time.

He always tells the lab who gets which report. The lab techs are wonderful and fully understand what he says, but the lab office staff just sends all the reports out to all the doctors, ignoring what my husband has said. We have spoken with the head of the lab and explained the problem. But they are so busy there, they just cannot seem to sort it all out. On occasion, they do do it right. And sometimes, they don't send out any of the reports. The doctors have to call the lab and ask for them to be FAXed. Plus they say they DO NOT take orders from the PATIENT.

When each doctor gets these reports, the ones who are not supposed to be getting the reports don't know what is happening and they act on the reports. We've had a situation when three doctors are reading the protime results and acting on them. This is a colossal waste of time and these guys are very busy. Sometimes we have three very annoyed people to deal with.

I have no idea how to correct this, short of what we have already done. I have also taken the time to call the doctors warning them of the possible mixup, but that message sometimes gets garbled, or the doctor doesn't get the message, or the lab might just do it right and thus my call will be useless and confusing.

We have also spoken to each doctor about how things get all mixed up.

So I can easily see why a busy office that is not supposed to act on the protime results would just pitch them, since keeping them around would generate extra unnecessary work of someone inadvertently reading them and then acting on them figuring out dosages, when their time could be used for somthing valid.

If you read this and find it clear as mud, that's intentional. It is clear as mud, it's a problem, and I bet it's pretty common. Doctors offices get innundated with all kinds of paperwork, some of it "time is of the essence" stuff, and some of it is stuff just for the file. Trying to figure out which is which can be tough.

 

[Karlynn]

Harp,
Have you tried getting a home test unit? Contact QAS, they get the ball rolling for you and do a lot of the work in getting you approved for you insurance coverage.

 

[JimL]

I'm not sure I understand, but this sounds like what I saw in my file at the card's office last fall. My file is quite thick, and much of it is INR reports. I think I suggested that they might just pitch a few of those pages, since the INR report is only good for a short time, pretty much the day it's taken.
I have a "Coumadin Dosage Calendar" put out by DuPont, in which I record everything, mainly my daily dosage, my weekly INR test, and my weekly dosage. I get the little booklet at the coumadin clinic; one kind lasts for four months, but I have several of the annual variety.
Since I record all of this information for myself, I have a record that goes back quite some time. I'm not really too concerned whether they keep those INR pages or throw them away, as long as I get the results of the test, which I always do.

 

[catwoman]

Harp:

I'm going to echo Karlynn: Have you tried getting a home test unit?

I test weekly, since travel does throw a wrench into maintaining a stable INR. Last week when I called the results to my PCP, one of his nurses asked if I adjust my med as needed. I now have an algorithm chart from Al, so I'm going to run it by there next week and see if Dr. Murphy will let me adjust, as long as I still phone in results and inform them of any dosage adjustments.

 

[Harpoon]

Nancy>> Is it possible for the lab to send YOU a copy of Joe's reports????

Perhaps the best way to keep everything straight for all of Joe's doctors is for you to do it, instead of letting a bunch of nurses and medical secretaries who don't know eachother try and sort everything out every time he gets a blood draw.... I dunno if the rules allow test results to be sent directly to the patient, but if they do, it might be the best way to keep it straight, even if reports get sent to the wrong docs as well, at least YOU have the right information for the right doctor and you can provide it if they didn't get a copy or got the wrong report. Just a thought.


I BRIEFLY looked into home testing, basically asked my PCP about it and his opinion is that my insurance wouldn't cover it. I might be a little more persistant though and ask the insurance people directly, or maybe talk to QAS. I have to admit though, I'm just starting to look into the home testing idea so I have absolutely NO CLUE. =)

To get tested (either through my PCP's office or the hospital) means a half hour drive out and back plus whatever time in the office to get the testing done at least once a month (that's where all my docs have me right now, testing monthly.)

If I can do it at home, obviously that takes out the driving time and it becomes a hell of a lot more convienient, but that's it really. I'll still get tested either way, just a matter of how much time out of my day it will take.

And of course gas for the car to get out and back. Right now the low grade is $1.87 a gallon as I recall. I remember when it used to be 83 cents, I think I was ten or twelve years old. =Þ


The PT/INR reports and dosing charts (my PCP refered to them as a "flow chart") probably don't need to go back very far. I dunno for sure. Doctors want to know if your INR goes wildy all over the place or if it's always steady as a rock. I guess you can corelate the data to other medical records, like when you changed medications or caught a cold or other factors that might change INR readings. The further back those readings go, the more of a pattern you can distingush, but does it need to go back years?

Dunno. A log for keeping track of your own scores and dosage would be nice.... If I had that, I could just give a copy to my PCP and be settled. Oh well.

 

[ccrawford]

Harpoon - Most medical info systems are like a seive and, as you have learned, can really be frustrating. I've done a few things that seem to help. I'm a home tester and set my own dosage, but I email my INR to the Coumadin clinic each time for their records. (I also take them candy the few times I see them). I keep my own calendar for other blood tests, and remind my cardio by email that he needs to send me an RX for the blood work. The lab results invariably get cubbyholed somewhere so I remind my cardio ten days post test that he should have the results. If he doesn't I check with my PCP, the lab, and sometimes my cardio's nurse. If I'm in a diagnostic situation, I always ask for copies of test results and carry them to subsequent exams in my briefcase. Hope this helps. Chris

 

[bvdr]

I keep copies of tests and other pertinent information and when one of my docs can't find something I can fax them a copy myself. It just seems to streamline things a bit. So much paperwork is generated that I am always pleasantly surprised when all the information is where it is supposed to be.

 

[Harpoon]

You know, I'm fairly certain my cadiologist has email (who doesn't these days, besides my grandparents, they're over 90 years old, each)

Wish I had it, would save on long distance charges...