Mrs. X checks in at 10:45 for her 11:15 appointment, just as she was asked. It takes her about 10 minutes to complete her paperwork, then she settles into a chair near the television and begins to watch the news. She sips on a cup of water from the water dispenser, then decides to have a cup of coffee. She wanders around the waiting room, glancing at several different magazines, before choosing one to flip through while she watches some more of the news.
The Technologist who will be performing her exam has had a rough morning. Her first patient was 30 minutes late, and eating a biscuit from Chik-fil-a. Her second patient was scheduled into a regular 15 minute exam slot, even though her patient information CLEARLY stated that she was a lower leg amputee with left-sided stroke paralysis who required additional time. (Too bad the "big" boss quietly informed the scheduling department that they are no longer allowed to add additional time for ANY reason.) The Tech managed to make up a little time, but then got backed up again waiting on the Radiologist to view diagnostic films, and waiting on two other patients who needed more views than usual due to their quite LARGE body habitus.
So it's now 11:40. The Technologist is running 25 minutes behind schedule. Mrs. X has had the 30 minutes she checked in early, plus an additional 25 minutes to wander around the waiting room, drink various beverages, watch TV and read. The Technologist comes to the waiting room door, obviously harried and trying to hurry.
"Mrs. X? Good afternoon, I'm Ms. Tech and I will be doing your Mammogram. If you'll just come this way please?"
Mrs. X holds her finger up at Ms. Tech, because she needs a minute to finish telling the person on the other end of her cell phone that the Technologist is here to get her now. Once she FINALLY hangs up, she gathers up the 2 cups she has, drops them (still half full) into the waste basket and watches them slosh over the side onto the carpet. Then she closes her magazine and places it back on the stack. After staring at it for a few seconds, she changes her mind, and picks it back up to bring with her. Then she hangs her purse from her walker, places her newly "acquired" magazine on the seat, straightens her sweater (while complaining about how terribly cold the waiting room is), turns to Ms. Tech and follows her (a FULL four minutes after she was called) to the exam room door.
"Mrs. X, if you'll just walk over to that chair, I've already laid a gown out for you. I need you to please remove......"
But Mrs. X interrupts with - "Wait! Where's the restroom?"
REALLY?!?!?!? NOW?!?!?!?!?!?!?
You haven't had enough time to get yourself up from the waiting room chair and find the restroom? You found the magazines! You found the coffee pot - TWICE!!! You found the water dispenser MULTIPLE TIMES!!! The lovely little receptionist that took your paperwork even mentioned to you that "If you need it, the restroom is right through THIS door and to the right." But hey, why doesn't Ms. Tech wait another 15 minutes for you to fight those super-elastic compression hose out from under the 58-hook girdle you're wearing? She's got nothing else to do -
EXCEPT MAYBE THOSE 14 OTHER PATIENTS SHE HAS TO SEE SITTING OUT THERE IN THE LOBBY NOW POURING THEMSELVES A CUP OF COFFEE!!!!!
People! TeeTee on your OWN TIME!!!! Or for crying out loud, just HOLD IT!!!! The exam only takes 15 minutes, and if you can't hold it THAT LONG then you're here for the wrong damned exam!!!
XrayFeet
Friday, September 24, 2010
Thursday, September 16, 2010
Trust Us! We Are Professionals!!!
ME: “Ma’am, do you have any metal on that skirt you’re wearing, like a zipper?”
PT: “Yes.”
ME: “Ok, is your skirt loose enough for you to just turn the waist so that the zipper is on the side?”
PT: (As she’s turning the skirt) “Yes.”
ME: “Terrific! Now come and have a seat here on this exam table! (while motioning toward the table)”
PT: “You mean as soon as I take off everything and put on a gown?”
Heavy sigh….
ME: “Sir, I need you to remove only your trousers and (while handing him a pair of shorts) put these shorts on. Everything else, including your underwear, is fine.”
Gentleman walks out of the changing area with the shorts on the floor, still folded, wearing nothing but underwear and a gown (which he had to have dug out himself) hanging open in the front. (He even took his socks off.)
ME: “Sir, why did you take off your shirt? I said you could leave on everything BUT your pants, and just put on the shorts I gave you.”
So he jumps up, dashes back behind the curtain, and in a few moments emerges with his underwear AND SHIRT on, and the gown still on and still hanging open in the front. But he did kick the shorts out of his way.
Shaking head….
ME: “Ma’am, please remove your blouse and bra, and put on this gown (handing it to her), with the opening to the back.”
PT: “What about my jewelry?”
ME: “No, ma’am.”
PT: “But you want me to take my watch off, right?”
ME: “No, ma’am.”
PT: “What about my glasses?”
ME: “NO ma’am!”
PT: She finally emerges, lays on the exam table, and just as I am beginning to scan her, SITS UP (banging her head on the c-arm right above her) and shouts, “But I have my partial in! Let me take it out!” as she’s trying to crawl OUT FROM UNDER the bone density c-arm.
ME: “Ma’am, if I had needed your jewelry, or watch, or glasses, or dentures removed, rest assured that I WOULD HAVE ASKED YOU TO DO SO!”
(Beginning to accept defeat…)
ME: “Ma’am, I need you to lie down here on the table, on your back please.”
PT: “Why?”
ME: “Because you came in for x-rays, and I’m going to take them.”
PT: “Yeah, but I came in for x-rays of my BACK!”
ME: “Yes, ma’am, I am fully aware of that. And I’m going to take the x-rays of your lower back.”
PT: (obviously growing agitated) “And yet you want me to lay on it?!?”
ME: “Yes.”
PT: (now yelling at me) “Well that’s pretty damn stupid! How the hell you gonna take x-rays of my back IF I’M LAYIN’ ON IT??”
ME: “Ma’am, do you have any zippers or metal eyelets at your waist?”
PT: “No.”
ME: “Great, then just come sit down over here on this table.”
PT: “But I haven’t taken off all of my clothes. I have to take my clothes off!”
ME: “No, ma’am, you do not. I just need you to come sit down on this exam table.”
PT: “I have a bra on.”
ME: “Yes, I assumed you did. Now please sit down.”
PT: “But it has HOOKS in it! METAL HOOKS!”
(OMG! When did they start making BRAS with METAL HOOKS???? I NEVER KNEW!!!!)
(After positioning a patient for a bone density exam)
PT: “You DO realize that this wrist brace has a metal bar in it, DON’T YOU?”
ME: “I am fully aware of that, ma’am.”
PT: “Well it’s going to show up!”
ME: “No ma’am, it’s not. If I were examining your wrist, it would, but like I just finished telling you, we are going to take a picture of your lower SPINE and left HIP, so I am positive that your WRIST BRACE is not going to affect my images!”
ME: “Ma’am, I need you to lie down on your back so that I can x-ray your ankle.”
PT: “Well, it hurts right here. (Pointing to the medial malleolus)”
ME: “Yes, ma’am, that’s why we are x-raying it.”
PT: “You just need to take a picture of that.”
ME: “No, ma’am, I have to take 3 pictures, all of which will include that area, so please lie down on your back.”
PT: “Well my doctor didn’t tell you to take all that! He just wants to see where I hurt it.”
ME: “Ma’am, your doctor was aware of our standard protocol for ankle imaging when he wrote the order. Our Radiologist will be expecting that protocol. The order that was written intended for me to FOLLOW that protocol. Now I STILL need you to lie down on your back!”
PT: “You’re just trying to make more money!”
Kids, are any of you aware of the educational requirements to become a Radiologic Technologist? It is a 2 year Associate of Science degree. We are taught anatomy, physiology, pathology, positioning, radiation protection, radiation physics and even the mechanical operations of our equipment. We also become BLS certified (that’s BASIC LIFE SUPPORT, which is a lil' more advanced than your run-of-the-mill CPR), learn venipuncture, and how to take an extensive history.
After all of that, we take a 260 question exam covering EVERY SINGLE ONE OF THOSE TOPICS PLUS SOME just to obtain our License. Then, depending on what state you live in, you may have to take an additional exam for the state. If you specialize in any modality beyond just plain ol’ x-ray, then you have more training, more classes, and another certification exam. For instance, someone like me (who’s an RT(R)(BD)(M) ) would have taken 3 certification exams, as well as a 40hour FDA mandated course in Mammography and classes in Cross-Sectional Anatomy, Computed Tomography and done a semester or two of CT clinical rotations.
I think, just maybe – POSSIBLY – I MIGHT KNOW WHAT THE HELL I AM DOING!!!!
Radiology has very set protocols. If you go to McDonald’s and order a cheeseburger, the kid with the runny nose and acne frying it up knows the “protocol”. He knows he slaps the fried patty on the bun with EXACTLY 2 pickle slices, a 1 & ½ -second long squirt of ketchup and some re-hydrated minced onions. Radiology uses the same principle.
If a doctor orders “ankle x-rays” he and the Radiologist and the Technologist all know that means that they are expecting to see an AP (front to back, otherwise known as AnteroPosterior – hence the AP), an oblique (with both malleoli in a perpendicular plane to the imaging plate so that the Mortise Joint is nice and open), and a lateral view (taken from the Medial to the Lateral – in other words with the outside of the ankle laying on the imaging plate). There are other views, but they are “Specialized” views, that the doctor and Radiologist will ask for by name depending on what they are looking for. The same holds true for every single body part – from the skull to the orbits to the scapula to the chest to the abdomen to the patella to the wrist to the elbow and femur even down to the big fat toe (which, by the way, is the left or right 1st digit or phalange, but specifically metatarsal). Each and every part has “Routine Views”, or a “Protocol”.
So when you go in for x-rays, please please PLEASE listen carefully to what the Technologist asks you to do. We are very specific, and we do actually try not to have you remove anything that we don’t absolutely need removed for YOUR benefit, not ours. Don’t argue with us, either. We really were well trained.
You can trust us.
WE ARE PROFESSIONALS!!!
Now would you PLEASE shut up and lie down on the table?!?
PT: “Yes.”
ME: “Ok, is your skirt loose enough for you to just turn the waist so that the zipper is on the side?”
PT: (As she’s turning the skirt) “Yes.”
ME: “Terrific! Now come and have a seat here on this exam table! (while motioning toward the table)”
PT: “You mean as soon as I take off everything and put on a gown?”
Heavy sigh….
ME: “Sir, I need you to remove only your trousers and (while handing him a pair of shorts) put these shorts on. Everything else, including your underwear, is fine.”
Gentleman walks out of the changing area with the shorts on the floor, still folded, wearing nothing but underwear and a gown (which he had to have dug out himself) hanging open in the front. (He even took his socks off.)
ME: “Sir, why did you take off your shirt? I said you could leave on everything BUT your pants, and just put on the shorts I gave you.”
So he jumps up, dashes back behind the curtain, and in a few moments emerges with his underwear AND SHIRT on, and the gown still on and still hanging open in the front. But he did kick the shorts out of his way.
Shaking head….
ME: “Ma’am, please remove your blouse and bra, and put on this gown (handing it to her), with the opening to the back.”
PT: “What about my jewelry?”
ME: “No, ma’am.”
PT: “But you want me to take my watch off, right?”
ME: “No, ma’am.”
PT: “What about my glasses?”
ME: “NO ma’am!”
PT: She finally emerges, lays on the exam table, and just as I am beginning to scan her, SITS UP (banging her head on the c-arm right above her) and shouts, “But I have my partial in! Let me take it out!” as she’s trying to crawl OUT FROM UNDER the bone density c-arm.
ME: “Ma’am, if I had needed your jewelry, or watch, or glasses, or dentures removed, rest assured that I WOULD HAVE ASKED YOU TO DO SO!”
(Beginning to accept defeat…)
ME: “Ma’am, I need you to lie down here on the table, on your back please.”
PT: “Why?”
ME: “Because you came in for x-rays, and I’m going to take them.”
PT: “Yeah, but I came in for x-rays of my BACK!”
ME: “Yes, ma’am, I am fully aware of that. And I’m going to take the x-rays of your lower back.”
PT: (obviously growing agitated) “And yet you want me to lay on it?!?”
ME: “Yes.”
PT: (now yelling at me) “Well that’s pretty damn stupid! How the hell you gonna take x-rays of my back IF I’M LAYIN’ ON IT??”
ME: “Ma’am, do you have any zippers or metal eyelets at your waist?”
PT: “No.”
ME: “Great, then just come sit down over here on this table.”
PT: “But I haven’t taken off all of my clothes. I have to take my clothes off!”
ME: “No, ma’am, you do not. I just need you to come sit down on this exam table.”
PT: “I have a bra on.”
ME: “Yes, I assumed you did. Now please sit down.”
PT: “But it has HOOKS in it! METAL HOOKS!”
(OMG! When did they start making BRAS with METAL HOOKS???? I NEVER KNEW!!!!)
(After positioning a patient for a bone density exam)
PT: “You DO realize that this wrist brace has a metal bar in it, DON’T YOU?”
ME: “I am fully aware of that, ma’am.”
PT: “Well it’s going to show up!”
ME: “No ma’am, it’s not. If I were examining your wrist, it would, but like I just finished telling you, we are going to take a picture of your lower SPINE and left HIP, so I am positive that your WRIST BRACE is not going to affect my images!”
ME: “Ma’am, I need you to lie down on your back so that I can x-ray your ankle.”
PT: “Well, it hurts right here. (Pointing to the medial malleolus)”
ME: “Yes, ma’am, that’s why we are x-raying it.”
PT: “You just need to take a picture of that.”
ME: “No, ma’am, I have to take 3 pictures, all of which will include that area, so please lie down on your back.”
PT: “Well my doctor didn’t tell you to take all that! He just wants to see where I hurt it.”
ME: “Ma’am, your doctor was aware of our standard protocol for ankle imaging when he wrote the order. Our Radiologist will be expecting that protocol. The order that was written intended for me to FOLLOW that protocol. Now I STILL need you to lie down on your back!”
PT: “You’re just trying to make more money!”
Kids, are any of you aware of the educational requirements to become a Radiologic Technologist? It is a 2 year Associate of Science degree. We are taught anatomy, physiology, pathology, positioning, radiation protection, radiation physics and even the mechanical operations of our equipment. We also become BLS certified (that’s BASIC LIFE SUPPORT, which is a lil' more advanced than your run-of-the-mill CPR), learn venipuncture, and how to take an extensive history.
After all of that, we take a 260 question exam covering EVERY SINGLE ONE OF THOSE TOPICS PLUS SOME just to obtain our License. Then, depending on what state you live in, you may have to take an additional exam for the state. If you specialize in any modality beyond just plain ol’ x-ray, then you have more training, more classes, and another certification exam. For instance, someone like me (who’s an RT(R)(BD)(M) ) would have taken 3 certification exams, as well as a 40hour FDA mandated course in Mammography and classes in Cross-Sectional Anatomy, Computed Tomography and done a semester or two of CT clinical rotations.
I think, just maybe – POSSIBLY – I MIGHT KNOW WHAT THE HELL I AM DOING!!!!
Radiology has very set protocols. If you go to McDonald’s and order a cheeseburger, the kid with the runny nose and acne frying it up knows the “protocol”. He knows he slaps the fried patty on the bun with EXACTLY 2 pickle slices, a 1 & ½ -second long squirt of ketchup and some re-hydrated minced onions. Radiology uses the same principle.
If a doctor orders “ankle x-rays” he and the Radiologist and the Technologist all know that means that they are expecting to see an AP (front to back, otherwise known as AnteroPosterior – hence the AP), an oblique (with both malleoli in a perpendicular plane to the imaging plate so that the Mortise Joint is nice and open), and a lateral view (taken from the Medial to the Lateral – in other words with the outside of the ankle laying on the imaging plate). There are other views, but they are “Specialized” views, that the doctor and Radiologist will ask for by name depending on what they are looking for. The same holds true for every single body part – from the skull to the orbits to the scapula to the chest to the abdomen to the patella to the wrist to the elbow and femur even down to the big fat toe (which, by the way, is the left or right 1st digit or phalange, but specifically metatarsal). Each and every part has “Routine Views”, or a “Protocol”.
So when you go in for x-rays, please please PLEASE listen carefully to what the Technologist asks you to do. We are very specific, and we do actually try not to have you remove anything that we don’t absolutely need removed for YOUR benefit, not ours. Don’t argue with us, either. We really were well trained.
You can trust us.
WE ARE PROFESSIONALS!!!
Now would you PLEASE shut up and lie down on the table?!?
Wednesday, August 11, 2010
Rules of Etiquette For Cell Phones
Dear ARRTy,
Why are Health Care Professionals always SO RUDE to me when they call me back for my appointment? I had an appointment just the other day, and the Technologist had the audacity to tell me that I had to go back out in the waiting room until I was finished with my phone call! Can you believe that?!?
Signed, Gabby in Galveston
Dear Gabby,
Let me just start by saying HANG UP THE BLOODY PHONE ALREADY!!!! You are SO RUDE! I'll bet you are the kind of person that has that cell phone constantly glued to your ear, aren't you? You probably walk around yack-yack-yacking all day long, droning pointlessly on about inconsequential nonsense, utterly oblivious to everyone around you, not caring how much you inconvenience anyone who's waiting for you to pull into your parking space, write the check for your groceries, or pay attention to the vital instructions that your Health Care Provider is trying to give to you before your exam.
The rest of the world is quite frankly not as interested in your life as you are. We are simply hostages, held powerlessly in line behind you or next to you in the waiting room while being subjected to your insipid verbal diarrhea. Just for the record hon, NOONE CARES that your cat has not had regular bowel movements for the last week. NOONE CARES that your sister's son-in-law's cousin's boyfriend was arrested for DUI again last week. ABSOLUTELY NOONE CARES about your opinion of the lastest "New & Improved" status of your favorite feminine hygiene wash!
YOU - on the other hand - just MIGHT be interested in hearing what your Health Care Provider has to say to you. We have such important information as:
"You know, if you walk in to the MRI room with that cell phone plugged up against your ear, not only is it going to kill your battery (GASP!) but your phone will most likely go FLYING through the air and stick itself to the side of the BIG GIANT MAGNET. At which point, we are going to have to cancel every patient for the rest of the entire afternoon while we squelch the machine, shutting everything down, so that we can retrieve your infernal cell phone - or at least what's LEFT of it."
(Translation - Do NOT walk in here with that damn cell phone!)
-and-
"Ma'am, I'm about to drive this very long needle into your gluteus maximus filled with a noxious substance designed to irradicate that nasty little infection that is percolating in your nether regions. Do you think you could possibly disengage that cell phone from the various orifices on your face long enough to let me know if you are going to go into anaphylactic shock after I administer this?"
(Translation - Would you hang the hell up and tell me if you have any drug allergies?!?!?)
-and-
"Sir, that pacemaker so precariously controlling your heartbeat is EXTREMELY susceptible to interference from radio, magnetic and micro waves. You would most likely not be flailing on the floor right now in atrial defibrillation had you chosen to disconnect that incredibly fascinating phone call about how amazing your cow's insemination was last week and instead listened to me as I tried to stop you from entering the MRI area."
(Translation: If you had hung up you would have heard me telling you to stop, and you would not now be clutching your chest with a heart attack.)
-and-
"Ma'am, it is critical that you consume large amounts of liquids, preferably water, for the rest of the afternoon in order to sufficiently flush the barium contrast from your digestive tract."
(Translation: If you don't get enough water in your gut, that chalky white crap we made you drink before your CT is going to get rock hard. If you think you had a belly ache before you came in today, wait until you haven't been able to poop for 4 days.)
So, kiddies, the lesson learned from Dear ARRTy today? While you may erroneously believe that your phone conversation is paramount in the grand scheme of the world's dynamics, we lowly Health Care Providers are simply attempting to provide you with the best care we can possibly give. To accomplish that, we need your undivided attention to listen to instructions, as well as answer vital questions concerning your health history. You cannot possibly do that while busily conversing with your first husband's aunt's hairdresser concerning whether she thinks it was appropriate for your first husband's aunt to get highlights. I realize that creation as we know it may come to a screeching halt if that particular matter is not diligently dissected, but then again YOUR personal creation could be at stake here as well.
So besides the fact that the general public at large is entirely exasperated by your incessant prattling, your attention while in your Health Care Provider's office would not only be THE POLITE THING TO DO, you might just find that the information we have to share with you is MEANINGFUL!!! (Translation: Put that damn cell phone away and pay attention to me before I cram your cell phone up your ass!)
Why are Health Care Professionals always SO RUDE to me when they call me back for my appointment? I had an appointment just the other day, and the Technologist had the audacity to tell me that I had to go back out in the waiting room until I was finished with my phone call! Can you believe that?!?
Signed, Gabby in Galveston
Dear Gabby,
Let me just start by saying HANG UP THE BLOODY PHONE ALREADY!!!! You are SO RUDE! I'll bet you are the kind of person that has that cell phone constantly glued to your ear, aren't you? You probably walk around yack-yack-yacking all day long, droning pointlessly on about inconsequential nonsense, utterly oblivious to everyone around you, not caring how much you inconvenience anyone who's waiting for you to pull into your parking space, write the check for your groceries, or pay attention to the vital instructions that your Health Care Provider is trying to give to you before your exam.
The rest of the world is quite frankly not as interested in your life as you are. We are simply hostages, held powerlessly in line behind you or next to you in the waiting room while being subjected to your insipid verbal diarrhea. Just for the record hon, NOONE CARES that your cat has not had regular bowel movements for the last week. NOONE CARES that your sister's son-in-law's cousin's boyfriend was arrested for DUI again last week. ABSOLUTELY NOONE CARES about your opinion of the lastest "New & Improved" status of your favorite feminine hygiene wash!
YOU - on the other hand - just MIGHT be interested in hearing what your Health Care Provider has to say to you. We have such important information as:
"You know, if you walk in to the MRI room with that cell phone plugged up against your ear, not only is it going to kill your battery (GASP!) but your phone will most likely go FLYING through the air and stick itself to the side of the BIG GIANT MAGNET. At which point, we are going to have to cancel every patient for the rest of the entire afternoon while we squelch the machine, shutting everything down, so that we can retrieve your infernal cell phone - or at least what's LEFT of it."
(Translation - Do NOT walk in here with that damn cell phone!)
-and-
"Ma'am, I'm about to drive this very long needle into your gluteus maximus filled with a noxious substance designed to irradicate that nasty little infection that is percolating in your nether regions. Do you think you could possibly disengage that cell phone from the various orifices on your face long enough to let me know if you are going to go into anaphylactic shock after I administer this?"
(Translation - Would you hang the hell up and tell me if you have any drug allergies?!?!?)
-and-
"Sir, that pacemaker so precariously controlling your heartbeat is EXTREMELY susceptible to interference from radio, magnetic and micro waves. You would most likely not be flailing on the floor right now in atrial defibrillation had you chosen to disconnect that incredibly fascinating phone call about how amazing your cow's insemination was last week and instead listened to me as I tried to stop you from entering the MRI area."
(Translation: If you had hung up you would have heard me telling you to stop, and you would not now be clutching your chest with a heart attack.)
-and-
"Ma'am, it is critical that you consume large amounts of liquids, preferably water, for the rest of the afternoon in order to sufficiently flush the barium contrast from your digestive tract."
(Translation: If you don't get enough water in your gut, that chalky white crap we made you drink before your CT is going to get rock hard. If you think you had a belly ache before you came in today, wait until you haven't been able to poop for 4 days.)
So, kiddies, the lesson learned from Dear ARRTy today? While you may erroneously believe that your phone conversation is paramount in the grand scheme of the world's dynamics, we lowly Health Care Providers are simply attempting to provide you with the best care we can possibly give. To accomplish that, we need your undivided attention to listen to instructions, as well as answer vital questions concerning your health history. You cannot possibly do that while busily conversing with your first husband's aunt's hairdresser concerning whether she thinks it was appropriate for your first husband's aunt to get highlights. I realize that creation as we know it may come to a screeching halt if that particular matter is not diligently dissected, but then again YOUR personal creation could be at stake here as well.
So besides the fact that the general public at large is entirely exasperated by your incessant prattling, your attention while in your Health Care Provider's office would not only be THE POLITE THING TO DO, you might just find that the information we have to share with you is MEANINGFUL!!! (Translation: Put that damn cell phone away and pay attention to me before I cram your cell phone up your ass!)
Friday, July 30, 2010
Tardiness Is NOT Next To Godliness!
Folks, if your appointment is at 10:00am, DO NOT SHOW UP AT 10:00AM!!!
There is a reason why we in the health care industry make those "day before your appointment" phone calls. It's called a REMINDER!!!! And during that reminder, we ALWAYS ALWAYS ALWAYS ask you to arrive BEFORE your scheduled appointment time. Some places say 15 minutes, some say 30, but we ALL SAY IT!!!!!
Now, would you like to know WHY we ask you to be early?
Ok, consider this scenario -
Ms. Tech arrives at work at 7:45am to turn on all of her equipment and do her daily quality control checks. She looks at her schedule, and it's CRAM PACKED. The boss is a firm believer in "productivity" so there is a patient scheduled in every single 15 minute block of time all day long. Not counting her lunch hour, that's 28 patients she's going to see today!!!
Her first patient is at 8am. The doors have been open since 7:30 (so folks can arrive BEFORE THEIR SCHEDULED APPOINTMENT TIME - see how that works?) But it's now 8:05 and her first patient has not arrived. Her 8:15 patient however, arrived at 7:50. And her 8:30 patient is checking in now.
Then, strolling leisurely through the door with a Chick-Fil-A biscuit in one hand and balancing a cup of coffee with her very large purse comes the 8:00am patient. She signs in, but cannot find her insurance card in the deep dark depths of the cave she calls her purse. It is now 8:10. It takes her another 10 minutes to fill out her paperwork. "How should I know when I had my hysterectomy?" (Please refer to the previous blog...) It is now 8:20. She is "officially" 20 minutes late for her appointment.
The dilemma for Ms. Tech is this:
Does she just skip the 8:00 patient and call back the 8:15 patient on time? Or does she wait for the 8:00 patient to finally be ready to be seen? The 8:15 patient will be angry if she is kept waiting past HER appointment time, and then the 8:30 patient will be late, and the 8:45, and the 9:00, and the 9:15 (you folks seeing a pattern here?) And this is only the FIRST patient of the morning. So far, it's looking like 27 patients are going to have to wait 20 minutes for THEIR appointment time because Biscuit Lady wouldn't wait for Chick-Fil-A. What happens if anybody ELSE is late?!?
Then again, if she skips the 8:00 LATE patient, and heads on to the 8:15, and 8:30, and 8:45, and 9:00 then when does she find the time to magically work the 8:00 patient back into the schedule? Every single block is filled, because heavens forbid the boss sees an empty time slot! Wait, the 9:00 just called to cancel. (Thank goodness SOME people have courtesy, huh? Even if it WAS at the last minute...) Ok, now she has time. But guess what? The 8:00 patient is swinging her biscuit around in the middle of the waiting room, spraying everyone else with (what we hope is) strawberry jelly while yelling at the office manager (Ms. Tech's boss) about how she's been kept waiting for "ALMOST AN HOUR! This is HORRIBLE service!" Now, the office manager is angry at Ms. Tech and writes her up for poor customer service.
So, what do you think that Ms. Tech is going to do? Do you think she's going to do what she SHOULD do, which is continue on with her morning in order to accommodate those patients who had the courtesy to show up for their appointments on time and prepared, so as not to inconvenience them? Awww, you're just precious! You really think that Ms. Tech can AFFORD to be written up or put her job in danger? Come on, she's got kids at home that she has to feed. A mortgage payment to make. A car that she'd rather not have re-possessed.
So, I'm gonna need you to just settle down in your chair in that waiting room and hush. Because Ms. Tech is going to be forced to cover her own ass.
"Mrs. Biscuit-Slurping Latecomer? Please come back now."
There is a reason why we in the health care industry make those "day before your appointment" phone calls. It's called a REMINDER!!!! And during that reminder, we ALWAYS ALWAYS ALWAYS ask you to arrive BEFORE your scheduled appointment time. Some places say 15 minutes, some say 30, but we ALL SAY IT!!!!!
Now, would you like to know WHY we ask you to be early?
Ok, consider this scenario -
Ms. Tech arrives at work at 7:45am to turn on all of her equipment and do her daily quality control checks. She looks at her schedule, and it's CRAM PACKED. The boss is a firm believer in "productivity" so there is a patient scheduled in every single 15 minute block of time all day long. Not counting her lunch hour, that's 28 patients she's going to see today!!!
Her first patient is at 8am. The doors have been open since 7:30 (so folks can arrive BEFORE THEIR SCHEDULED APPOINTMENT TIME - see how that works?) But it's now 8:05 and her first patient has not arrived. Her 8:15 patient however, arrived at 7:50. And her 8:30 patient is checking in now.
Then, strolling leisurely through the door with a Chick-Fil-A biscuit in one hand and balancing a cup of coffee with her very large purse comes the 8:00am patient. She signs in, but cannot find her insurance card in the deep dark depths of the cave she calls her purse. It is now 8:10. It takes her another 10 minutes to fill out her paperwork. "How should I know when I had my hysterectomy?" (Please refer to the previous blog...) It is now 8:20. She is "officially" 20 minutes late for her appointment.
The dilemma for Ms. Tech is this:
Does she just skip the 8:00 patient and call back the 8:15 patient on time? Or does she wait for the 8:00 patient to finally be ready to be seen? The 8:15 patient will be angry if she is kept waiting past HER appointment time, and then the 8:30 patient will be late, and the 8:45, and the 9:00, and the 9:15 (you folks seeing a pattern here?) And this is only the FIRST patient of the morning. So far, it's looking like 27 patients are going to have to wait 20 minutes for THEIR appointment time because Biscuit Lady wouldn't wait for Chick-Fil-A. What happens if anybody ELSE is late?!?
Then again, if she skips the 8:00 LATE patient, and heads on to the 8:15, and 8:30, and 8:45, and 9:00 then when does she find the time to magically work the 8:00 patient back into the schedule? Every single block is filled, because heavens forbid the boss sees an empty time slot! Wait, the 9:00 just called to cancel. (Thank goodness SOME people have courtesy, huh? Even if it WAS at the last minute...) Ok, now she has time. But guess what? The 8:00 patient is swinging her biscuit around in the middle of the waiting room, spraying everyone else with (what we hope is) strawberry jelly while yelling at the office manager (Ms. Tech's boss) about how she's been kept waiting for "ALMOST AN HOUR! This is HORRIBLE service!" Now, the office manager is angry at Ms. Tech and writes her up for poor customer service.
So, what do you think that Ms. Tech is going to do? Do you think she's going to do what she SHOULD do, which is continue on with her morning in order to accommodate those patients who had the courtesy to show up for their appointments on time and prepared, so as not to inconvenience them? Awww, you're just precious! You really think that Ms. Tech can AFFORD to be written up or put her job in danger? Come on, she's got kids at home that she has to feed. A mortgage payment to make. A car that she'd rather not have re-possessed.
So, I'm gonna need you to just settle down in your chair in that waiting room and hush. Because Ms. Tech is going to be forced to cover her own ass.
"Mrs. Biscuit-Slurping Latecomer? Please come back now."
Tuesday, July 27, 2010
I'm Gonna Need You To Take Responsibility, People!
Ok, I've got a pop quiz for ya:
When (yes, exactly) was your last medical check-up? With WHOM was it? Do you take prescription medications? Do you know the name and dosage? Do you even know what you take it for?
Have you had any medical tests done? What is the ACTUAL name of the test, where was it, and what were your results? How about surgical procedures? Do you know the dates and places of those?
For instance - ladies, when and where was your last pap smear? Mammogram?
Do your answers sound like "Ummm, maybe a year ago? No, no, wait - it was a year and a half ago. I think. At that place, you know, by the hospital? Downtown? I don't remember the name of it. And nobody told me my results. I'm sure it was fine though." ??? Really?!?!?
Then listen up, because I'm only going to say this once!
IT'S YOUR HEALTH PEOPLE!!!! TAKE RESPONSIBILITY FOR IT!!!!!
As a healthcare professional, I ask patients questions like these all day. Just last week I asked a lady, "Ma'am, have you had a hysterectomy?" She said, "NO! The only surgery I've ever had was when they took my uterus out!" Whaaa?!? Here's some other gems that I've actually been told:
Me "I see you had a Bone Density exam. What were your results?"
Patient "FINE! My bones are in good shape!"
Me "Ok, and what medications are you taking?"
Patient "Boniva."
Really? FYI, Boniva is a prescription medicine used only to reverse bone loss - in other words, for patients that have been diagnosed with Osteoporosis or Osteopenia. But her bones were GOOD.
Me "When did you have your hysterectomy?"
Patient "Good lord girl, how should I know? That was YEARS ago!"
Me "I see you've written on your questionairre that you've had back surgery. What kind of procedure did you have done?"
Patient "They did something to L8 or 9. But I don't know what."
Me "Sir, there are only 5 Lumbar vertebrae."
Patient "Oh, right! It was D 8 and 9."
(Let's see - cervical, thoracic, lumbar, sacrum/cocyxx - nope, no D spine!)
Me "Have you had any surgeries on your hips or lower back?"
Patient "No."
Me (while scanning the hip) "You have a rod in your femur. You said you hadn't had any surgeries on your hip."
Patient "I haven't! I broke my leg, not my hip. They put a rod in it that goes all the way up to the top." People, FYI - your femur and your pelvis work together to make your HIP. And if you broke it, you should've already known that!
Me "Do you take any medications for your thyroid?"
Patient "I don't have a thyroid!"
Me "So you've had it removed?"
Patient "No, I don't have one!"
Me "Have you ever had Hormone Replacement Therapy?"
Patient "No."
Me "So after your hysterectomy at 35, they didn't get you Estrogen? Or Premarin, maybe?"
Patient "Oh yeah, I take Premarin!"
Me "Ma'am, you're 76. You are STILL taking Premarin?!?"
Patient "Well, yeah! Every time I try to stop, I get hot flashes."
Me "Where was your last mammogram?" Patient "Here."
Me "Well, the last mammogram you had HERE was in 2005."
Patient "That's ridiculous! I have one EVERY year! I come here all the time!" Me "Ma'am, I pulled all of your previous exams here, and while yes, you have had several other types of exams here, your last mammogram here was 5 years ago."
Patient "Oh, well maybe it was at that place on Fredricksburg..."
Now, yes, these are humorous stories. However, now that you'd had a good giggle, tell the truth... Have you ever given answers like these? You can't depend on your physician to know about everything you've ever had done. Test results get lost, or don't get sent at all. You change cities, you change physicians, facilities close...I know of one that burned down - yes, with all of their patient's records inside.
So it's up to you to take charge of your own health! Keep a written master record, and take it with you whenever you go to the doctor's or to have tests done. That way, WHILE YOU ARE THERE, you can ask for the exact name of the medication or test, why it is necessary, etc. as well as note when and where! Let's face it, as we get older it gets harder and harder to remember things. Maybe at the time you went through menopause it was a big deal, but 20 years later is it still important enough for you to remember how old you were when it happened? I had a tonsillectomy when I was a teenager. It was PURE TEEN DRAMA at the time, but now? Come on...
It may not seem like the age you were when you had a hysterectomy will be relevant when you are 65, but it is! Did you know that early onset of menopause, even if surgically induced by a hysterectomy, can raise your risk of osteoporosis? Were you aware that certain kinds of medications can raise your risk of breast cancer? Did you know that excessive exposure to radiation can increase your risk of cancer in general? If you had a CT scan of your abdomen just last week, do you really need the additional exposure of another CT scan this week? If it's medically necessary, that's fine, but if it's because a different physician is ordering it because he or she has no idea you just had one.....
I'm not saying that you need to research everything yourself. But I am saying that it's vitally important to keep track of YOUR OWN RECORDS!!!! The Health Care Professionals taking care of you will know what's relevant to what, but they can't help you make intelligent decisions about your care if they only have half the picture.
So, the next time you are at a health related appointment, and your caregiver asks you, "Have you had a recent chest x-ray?" you can say, "Let me check my record sheet..... Why yes, I had a chest x-ray 7 months ago at ABC Imaging on Main St. I have it on a CD right here." Your health care provider will be able to give you much more thorough care, and that's all you really want anyway, isn't it??!?!?
When (yes, exactly) was your last medical check-up? With WHOM was it? Do you take prescription medications? Do you know the name and dosage? Do you even know what you take it for?
Have you had any medical tests done? What is the ACTUAL name of the test, where was it, and what were your results? How about surgical procedures? Do you know the dates and places of those?
For instance - ladies, when and where was your last pap smear? Mammogram?
Do your answers sound like "Ummm, maybe a year ago? No, no, wait - it was a year and a half ago. I think. At that place, you know, by the hospital? Downtown? I don't remember the name of it. And nobody told me my results. I'm sure it was fine though." ??? Really?!?!?
Then listen up, because I'm only going to say this once!
IT'S YOUR HEALTH PEOPLE!!!! TAKE RESPONSIBILITY FOR IT!!!!!
As a healthcare professional, I ask patients questions like these all day. Just last week I asked a lady, "Ma'am, have you had a hysterectomy?" She said, "NO! The only surgery I've ever had was when they took my uterus out!" Whaaa?!? Here's some other gems that I've actually been told:
Me "I see you had a Bone Density exam. What were your results?"
Patient "FINE! My bones are in good shape!"
Me "Ok, and what medications are you taking?"
Patient "Boniva."
Really? FYI, Boniva is a prescription medicine used only to reverse bone loss - in other words, for patients that have been diagnosed with Osteoporosis or Osteopenia. But her bones were GOOD.
Me "When did you have your hysterectomy?"
Patient "Good lord girl, how should I know? That was YEARS ago!"
Me "I see you've written on your questionairre that you've had back surgery. What kind of procedure did you have done?"
Patient "They did something to L8 or 9. But I don't know what."
Me "Sir, there are only 5 Lumbar vertebrae."
Patient "Oh, right! It was D 8 and 9."
(Let's see - cervical, thoracic, lumbar, sacrum/cocyxx - nope, no D spine!)
Me "Have you had any surgeries on your hips or lower back?"
Patient "No."
Me (while scanning the hip) "You have a rod in your femur. You said you hadn't had any surgeries on your hip."
Patient "I haven't! I broke my leg, not my hip. They put a rod in it that goes all the way up to the top." People, FYI - your femur and your pelvis work together to make your HIP. And if you broke it, you should've already known that!
Me "Do you take any medications for your thyroid?"
Patient "I don't have a thyroid!"
Me "So you've had it removed?"
Patient "No, I don't have one!"
Me "Have you ever had Hormone Replacement Therapy?"
Patient "No."
Me "So after your hysterectomy at 35, they didn't get you Estrogen? Or Premarin, maybe?"
Patient "Oh yeah, I take Premarin!"
Me "Ma'am, you're 76. You are STILL taking Premarin?!?"
Patient "Well, yeah! Every time I try to stop, I get hot flashes."
Me "Where was your last mammogram?" Patient "Here."
Me "Well, the last mammogram you had HERE was in 2005."
Patient "That's ridiculous! I have one EVERY year! I come here all the time!" Me "Ma'am, I pulled all of your previous exams here, and while yes, you have had several other types of exams here, your last mammogram here was 5 years ago."
Patient "Oh, well maybe it was at that place on Fredricksburg..."
Now, yes, these are humorous stories. However, now that you'd had a good giggle, tell the truth... Have you ever given answers like these? You can't depend on your physician to know about everything you've ever had done. Test results get lost, or don't get sent at all. You change cities, you change physicians, facilities close...I know of one that burned down - yes, with all of their patient's records inside.
So it's up to you to take charge of your own health! Keep a written master record, and take it with you whenever you go to the doctor's or to have tests done. That way, WHILE YOU ARE THERE, you can ask for the exact name of the medication or test, why it is necessary, etc. as well as note when and where! Let's face it, as we get older it gets harder and harder to remember things. Maybe at the time you went through menopause it was a big deal, but 20 years later is it still important enough for you to remember how old you were when it happened? I had a tonsillectomy when I was a teenager. It was PURE TEEN DRAMA at the time, but now? Come on...
It may not seem like the age you were when you had a hysterectomy will be relevant when you are 65, but it is! Did you know that early onset of menopause, even if surgically induced by a hysterectomy, can raise your risk of osteoporosis? Were you aware that certain kinds of medications can raise your risk of breast cancer? Did you know that excessive exposure to radiation can increase your risk of cancer in general? If you had a CT scan of your abdomen just last week, do you really need the additional exposure of another CT scan this week? If it's medically necessary, that's fine, but if it's because a different physician is ordering it because he or she has no idea you just had one.....
I'm not saying that you need to research everything yourself. But I am saying that it's vitally important to keep track of YOUR OWN RECORDS!!!! The Health Care Professionals taking care of you will know what's relevant to what, but they can't help you make intelligent decisions about your care if they only have half the picture.
So, the next time you are at a health related appointment, and your caregiver asks you, "Have you had a recent chest x-ray?" you can say, "Let me check my record sheet..... Why yes, I had a chest x-ray 7 months ago at ABC Imaging on Main St. I have it on a CD right here." Your health care provider will be able to give you much more thorough care, and that's all you really want anyway, isn't it??!?!?
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