Re: What to do with patient and a question for Graham

February 17, 2008

Yes, I have two - one 14, and one 19 years.

Often hospitals will give a patient a card listing all their

medications and timing to take home with them.

Of course, since 1/5 patients admitted to hospitals have some adverse

event, one has to take these lists with a grain of salt.

>

> should we take it that you own a teenager Graham??

>

> Have a NZ( ANY other country!!) question

> can you tell me do you know if there are troubles with

> or any system for, reconciling meds before and at admission to the

> hospitlas? That is ,this would matter if hospitlaists are used especially

> and I cannot recall if you told us that outpatietn and inpatietn care are

> separate? Nursing home care also-- is it not an issue becasue formularies

> are simple? Becasue the emrs communicate with each other There are so many

> trouble with that here...

> thanks

>

> > Ok, I'm not in primary care, but aren't you guys being a little hard on

> her?

> > She's 15 with chronic abdominal pain, and now pelvic pain. Isn't she

> > allowed to act up?

> >

> > >

> > > Dear Kris,

> > >

> > > , as usual, has excellent advice. I would write a very professional

> and

> > > compassionate letter outlining the problems that have come up in giving

> her

> > > appropriate care. Deliniate the contract requirements that you have.

> Tell

> > > her that if she chooses, she can leave your practice and you would be

> happy

> > > to give her referrals, or she can schedule an appointment (and make it a

> > > long one) to go over the contract and discuss the next steps in her care

> > > plan.

> > >

> > > Good luck with this one,

> > > Lonna

> > >

> > > mkcl6@... wrote:

> > >

> > > Would you send this contract to her? Require another visit? When she

> left my

> > > office on fri she wouldn't even meet my eye or answer my questions. I

> have

> > > to tell you I dread ever dealing with her again.

> > >

> > > What to do with patient

> > >

> > > I have a family of 6 as patients (for about 3 years now). They have a

> 15 yr

> > > old daughter who has intermittent abdominal pain that has been diagnosed

> as

> > > IBS by peds gastro. When she first came to me at 12 or 13 she had to be

> > > sedated for blood draws because of what her Mom said was trauma caused

> by

> > > her previous doctor. So anyway, she came in with a period she says was

> > > really heavy and lasted 2 months in Dec. I had to persuade her to allow

> labs

> > > (which showed probably PCOS based on testosterone levels) and wanted to

> do a

> > > pelvic and/or a pelvic ultrasound, which she vehemently refused. Her mom

> > > called later and said she wondered if we could try Yasmin, as a friend

> of

> > > hers was on it and it helped her menses and her irritable mood. So I

> agreed.

> > > I had also requested she see a gyn, she refused.

> > >

> > > So, another bit of background. These people are generally 15min late,

> when

> > > they call the Mom wants to talk forever, and I end up nearly hanging up

> on

> > > her and they are " quite prominent " in the community.

> > >

> > > Friday they came in, 25 minutes late, were told only 5 min of their appt

> > > time remained and that I was scheduled for more patients, and needed to

> > > leave on time. Of course they start into a huge history of this issue.

> Pt is

> > > now nauseated every morning and won't get up for school until lunchtime.

> I

> > > recommended stopping the ocps or switching to another and the pt

> screamed

> > > " NO " . I also suggested some anti nausea med but was concerned about

> fatigue

> > > etc.. I also said we could send to gyn and/or back to gi. She ended up

> > > screaming at me that she couldn't believe that was all I had to offer.

> Her

> > > mother basically sat there, then started trying to console her... At

> this

> > > point, I said I was going to go see my next patient and would return

> when

> > > she was calm. The pt then screamed " oh my god, you're going to leave

> NOW! "

> > > While in the next room I, the pt in the waiting area, the patient in my

> > > husband's office and the pt I was seeing could all her screaming her

> > > indignence at what I had offered her.

> > >

> > > When I came back, now very late for my own appt, she said to her mother,

> > > " you said if she came back, you would do the talking " . So we left it

> with

> > > her getting some otc emetrol, a script for reglan and another

> recommendation

> > > to try another ocp. I said to call me on Mon. and let me know where

> they

> > > were.

> > >

> > > Clearly, I can't have this kind of behavior, I know I need to do

> something

> > > and am thinking my only option is to fire this child. Does anyone have

> any

> > > ideas about whether I should talk to the mother about why? If there is

> > > anything else I should do?

> > >

> > > Part of my hesitation and or distress about this is after 13 years I had

> a

> > > pt contact a lawyer, this week, because I wouldn't give 90d of scripts

> > > without an appt, and she says I wasn't returning her calls.

> > >

> > > What a week. Kris

> > >

> > > ________________________________

> > >

> > > Delicious ideas to please the pickiest eaters. Watch the video on AOL

> > > Living.

> > >

> > > ________________________________

> > > More new features than ever. Check out the new AOL Mail!

> > >

> > > ________________________________

> > > Never miss a thing. Make Yahoo your homepage.

> > >

> >

> > --

> > Graham Chiu

> > http://www.synapsedirect.com

> > Synapse - the use from anywhere EMR.

> >

February 17, 2008

Oops, closer to 1/6

http://www.stuff.co.nz/4403291a20475.html

>

> 1/ 5 in NZ?? really? YOu are not doing better than we are?

> holy smokes!!

>

> >

> > Yes, I have two - one 14, and one 19 years.

> >

> > Often hospitals will give a patient a card listing all their

> > medications and timing to take home with them.

> >

> > Of course, since 1/5 patients admitted to hospitals have some adverse

> > event, one has to take these lists with a grain of salt.

> >

> > >

> > > should we take it that you own a teenager Graham??

> > >

> > > Have a NZ( ANY other country!!) question

> > > can you tell me do you know if there are troubles with

> > > or any system for, reconciling meds before and at admission to the

> > > hospitlas? That is ,this would matter if hospitlaists are used

> especially

> > > and I cannot recall if you told us that outpatietn and inpatietn care

> are

> > > separate? Nursing home care also-- is it not an issue becasue

> formularies

> > > are simple? Becasue the emrs communicate with each other There are so

> many

> > > trouble with that here...

> > > thanks

> > >

> > > > Ok, I'm not in primary care, but aren't you guys being a little hard

> on

> > > her?

> > > > She's 15 with chronic abdominal pain, and now pelvic pain. Isn't she

> > > > allowed to act up?

> > > >

> > > > >

> > > > > Dear Kris,

> > > > >

> > > > > , as usual, has excellent advice. I would write a very

> professional

> > > and

> > > > > compassionate letter outlining the problems that have come up in

> giving

> > > her

> > > > > appropriate care. Deliniate the contract requirements that you

> have.

> > > Tell

> > > > > her that if she chooses, she can leave your practice and you would

> be

> > > happy

> > > > > to give her referrals, or she can schedule an appointment (and make

> it a

> > > > > long one) to go over the contract and discuss the next steps in her

> care

> > > > > plan.

> > > > >

> > > > > Good luck with this one,

> > > > > Lonna

> > > > >

> > > > > mkcl6@... wrote:

> > > > >

> > > > > Would you send this contract to her? Require another visit? When she

> > > left my

> > > > > office on fri she wouldn't even meet my eye or answer my questions.

> I

> > > have

> > > > > to tell you I dread ever dealing with her again.

> > > > >

> > > > > What to do with patient

> > > > >

> > > > > I have a family of 6 as patients (for about 3 years now). They have

> a

> > > 15 yr

> > > > > old daughter who has intermittent abdominal pain that has been

> diagnosed

> > > as

> > > > > IBS by peds gastro. When she first came to me at 12 or 13 she had to

> be

> > > > > sedated for blood draws because of what her Mom said was trauma

> caused

> > > by

> > > > > her previous doctor. So anyway, she came in with a period she says

> was

> > > > > really heavy and lasted 2 months in Dec. I had to persuade her to

> allow

> > > labs

> > > > > (which showed probably PCOS based on testosterone levels) and wanted

> to

> > > do a

> > > > > pelvic and/or a pelvic ultrasound, which she vehemently refused. Her

> mom

> > > > > called later and said she wondered if we could try Yasmin, as a

> friend

> > > of

> > > > > hers was on it and it helped her menses and her irritable mood. So I

> > > agreed.

> > > > > I had also requested she see a gyn, she refused.

> > > > >

> > > > > So, another bit of background. These people are generally 15min

> late,

> > > when

> > > > > they call the Mom wants to talk forever, and I end up nearly hanging

> up

> > > on

> > > > > her and they are " quite prominent " in the community.

> > > > >

> > > > > Friday they came in, 25 minutes late, were told only 5 min of their

> appt

> > > > > time remained and that I was scheduled for more patients, and needed

> to

> > > > > leave on time. Of course they start into a huge history of this

> issue.

> > > Pt is

> > > > > now nauseated every morning and won't get up for school until

> lunchtime.

> > > I

> > > > > recommended stopping the ocps or switching to another and the pt

> > > screamed

> > > > > " NO " . I also suggested some anti nausea med but was concerned about

> > > fatigue

> > > > > etc.. I also said we could send to gyn and/or back to gi. She

> ended up

> > > > > screaming at me that she couldn't believe that was all I had to

> offer.

> > > Her

> > > > > mother basically sat there, then started trying to console her... At

> > > this

> > > > > point, I said I was going to go see my next patient and would return

> > > when

> > > > > she was calm. The pt then screamed " oh my god, you're going to

> leave

> > > NOW! "

> > > > > While in the next room I, the pt in the waiting area, the patient in

> my

> > > > > husband's office and the pt I was seeing could all her screaming her

> > > > > indignence at what I had offered her.

> > > > >

> > > > > When I came back, now very late for my own appt, she said to her

> mother,

> > > > > " you said if she came back, you would do the talking " . So we left

> it

> > > with

> > > > > her getting some otc emetrol, a script for reglan and another

> > > recommendation

> > > > > to try another ocp. I said to call me on Mon. and let me know where

> > > they

> > > > > were.

> > > > >

> > > > > Clearly, I can't have this kind of behavior, I know I need to do

> > > something

> > > > > and am thinking my only option is to fire this child. Does anyone

> have

> > > any

> > > > > ideas about whether I should talk to the mother about why? If there

> is

> > > > > anything else I should do?

> > > > >

> > > > > Part of my hesitation and or distress about this is after 13 years I

> had

> > > a

> > > > > pt contact a lawyer, this week, because I wouldn't give 90d of

> scripts

> > > > > without an appt, and she says I wasn't returning her calls.

> > > > >

> > > > > What a week. Kris

> > > > >

> > > > > ________________________________

> > > > >

> > > > > Delicious ideas to please the pickiest eaters. Watch the video on

> AOL

> > > > > Living.

> > > > >

> > > > > ________________________________

> > > > > More new features than ever. Check out the new AOL Mail!

> > > > >

> > > > > ________________________________

> > > > > Never miss a thing. Make Yahoo your homepage.

> > > > >

> > > >

> > > > --

> > > > Graham Chiu

> > > > http://www.synapsedirect.com

> > > > Synapse - the use from anywhere EMR.

> > > >

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