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Opinions, please. Below are two letters. One is what I wrote to the Practice Administrator of my gynecologist's office and the one below it is her reply. My letter to her explains the whole situation.

What I am trying to decide now is if I should find another gynecologist. I was expecting more of an apology. I believe some of my suggestions would have been in line with the HIPAA act that they mention and I hoped that they would change their procedures somewhat. I hate to think of others going through what I did but it looks like things there won't be changing. It isn't what happened to me that bothers me so much now as how the Administrator handled the response in her letter. And the mention of the office mistakes... that sort of concerns me, too. Am I being too hard on them? Should I stay or go? Please let me know your true thoughts...

My Letter to the Practice Administrator:

I am writing to tell you of a negative experience I had today with XX Gynecology. I have been a patient at this practice for about 20+ years and have never been in the situation of needing to write to you to complain, until today. Here is what happened:

I had eaten lunch out and then stopped by my house at 1:05 p.m. for what was going to be a few minutes to take care of my dogs, since I had a 1:45 meeting at work. I checked my answering machine and there was a message on it. It said something like this: “This is the nurse at XX Gynecology. I need to speak with you. Please call me at 555-5555. Press 0 for the operator and have her page Bettina.”

Well, I had no idea why she would be calling me and figured it was important if she wanted me to have her paged. Then I remembered that I had had a mammogram a week ago at YY Radiology and I thought maybe something was wrong with my mammogram. My cousin has breast cancer and when she told me how she found out, she said her gynecologist had called her to tell her she had a “bad” mammogram. So, when I got the call from your office, I was a nervous wreck! I tried calling back right away but you were closed until 2:00. I was so anxious that my heart was racing and I had to take an Inderal to get it to slow down. I tried calling YY Radiology to see if they could tell me anything but their office was also closed for lunch.

Even though I had a meeting at 1:45 I knew I couldn’t concentrate until I heard why she was calling me. And I wanted to hear any bad news away from the office. I finally left for the meeting at close to 2:00 and sat in the parking lot and called your office on my cell phone up until 2:05 but it was still closed. I finally felt I had to get to the meeting. While in the meeting all I could think about was why was your office calling me if it wasn’t something “bad”. We took a break at 3:00 and I ran to my office phone and called your office.

The receptionist told me the reason I had been called was that Dr. X had gotten my mammogram results and noticed I hadn’t had a gyn exam in two years. [As an aside… you all used to call when it was time for my appointment… I’ve had no reminder at all in two years.] I asked her why the nurse didn’t just tell me the call was about an appointment and how it had scared me so much. She was not at all empathetic about the anxiety your phone call had caused and said due to some law they could only give a name and phone number. I get messages on my answering machine from other medical offices all the time reminding me of appointments. In fact, I had one today from Dr. ZZ’s office reminding me of my eye exam appointment tomorrow.

Surely, the nurse who called could have said something to not scare the living daylights out of me. It took me all afternoon to get over this scare, especially since I had to wait so long to hear why you were calling. Can you just imagine if I had not gotten the message until after 5:00 when I came home from work and had to wait until morning to speak to someone?

There has to be another way to handle situations like this such as calling my office number (which you have on file) or sending me a note. Or just say it involves an appointment or scheduling issue… anything! You all should have more understanding of human nature not leave a message to call the nurse at the doctor’s office and not have them become concerned, especially after a recent mammogram. If I was to call the receptionist that would have been different… but the nurse!

I hope that you can review your policy and save other patients the anxiety that you caused me today. No one should have to go through what I went through when there were certainly other options available. I am now deciding whether I even want to remain a patient at a practice that has so little regard for a patient’s feelings.

======================
Her Reply:

Thank you for your letter. I do value you as our patient and wish to extend my apologies for all inconveniences that we may have caused you. HIPAA (Health Insurance Portability and Accountability Act) makes it very difficult for us to leave any form of voice message on telephone answering machines in detail in case you have other members in your household that may retrieve this message. We strive very hard to keep our patients individual identifiable health information private and confidential.

Secondly, we have changed computer programs and upgraded them for the year 2004 and with this transition mistakes have been made that we feel we have corrected as of this date. I did check your records and noted a recall letter was not generated for you and we have corrected that problem. As noted you are due for your annual exam and I hope you will feel favorable to call our office again and make that appointment with Dr. XX.

Again I thank you for taking the time to write me and I look forward to seeing you in the very near future.
 

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I wouldn't base my decision to leave on the phone message mishap, but that's possibly because I havent been through your situation.

Before jumping out to a different GYN give some thought to how you feel about the doctor etc. I personally find it hard to find a GYN who can make me comfortable enough that I'm not in a lot of discomfort physically.

HIPPA has made things a lot more difficult, my mom, who is a nurse, struggles with these situations herself.

This is a personal decision, and only you will know what's right in this situation...
 

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I can certainly understand your anxiety over the phone message. I too would have been a nervous wreck. I would give the gyn another chance. I would also speak to "Bettina" and tell her personally how her cryptic message made you worry.
 

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Hi, I've been there too. My main concern would be that other than this situation, are you comfortable with your dr.? Does she take good care of you? I would not worry too much about the incident, although I can see why you were so scared and nervous. If you like your dr, and have a good relationship with her I would stick with her. In my experience a good dr. is hard to find!! I am back in school studying pharmacy and HIPAA is a pain to get around. There are rules for everything!!!! It is for the benefit of the patient, but sometimes HIPAA just makes things so complicated.

As for the computer mistake, that has happened to me too. That is just something that we have to deal with now that our entire lives depend on computers. It sucks sometimes, because computer upgrades always cause some type of a temporary problem.

If it truly bothers you, it's your decision and I'm sure whatever you decide will be good for you!!!
 

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Discussion Starter #5
Originally posted by littlepeanut@Feb 26 2005, 06:18 PM
Hi, I've been there too.  My main concern would be that other than this situation, are you comfortable with your dr.?  Does she take good care of you?  I would not worry too much about the incident, although I can see why you were so scared and nervous.  If you like your dr, and have a good relationship with her I would stick with her.  In my experience a good dr. is hard to find!!  I am back in school studying pharmacy and HIPAA is a pain to get around.  There are rules for everything!!!!  It is for the benefit of the patient, but sometimes HIPAA just makes things so complicated.

As for the computer mistake, that has happened to me too.  That is just something that we have to deal with now that our entire lives depend on computers.  It sucks sometimes, because computer upgrades always cause some type of a temporary problem.

If it truly bothers you, it's your decision and I'm sure whatever you decide will be good for you!!!

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Hi, thanks for your thoughts. Do you know if HIPAA allows a doctor's office, though, to say the call involves an appointment or scheduling issue?
 

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I would definitely consider my relationship with the doctor to be my primary focus--a good gyn is hard to find.

Having said that, I can't believe that HIPAA won't allow them to state something like: we notice that you are due for your regular check-up or something to that effect. Our dentist and the chiro always do--doesn't HIPAA apply equally to all?

I think the staff handled your situation without any consideration of your feelings. That alone would make me switch. I can't stand being treated like a thing or a number. So many medical clinics do that to patients. However, if, like me, you are well insured and have an array of choices, I'd say take your business and your money somewhere you'll be treated with kindness and respect.
 

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I'm really only studying the pharmacy side of HIPAA (not too many phone call situations involved), so I can't be 100% sure.

It is very true what the woman said about not being able to disclose of any personal info about you on an answering machine. You see, there is just such a thin line before we break the rules of HIPAA and I honestly don't feel like I am qualified to answer your question.

I personally think it seems like it would be okay to say you are due for an appointment, but at the same time according to HIPAA, anyone who could possibly hear that message would know that you are in need of an appointment whether it be a routine check up or otherwise. HIPAA is obviously all about patient privacy and sometimes it gets into grey areas. Sorry I can't be more specific.
The privacy act hasn't completely sunk into my head yet. If I remember right, there are a few nurses on SM?? They'll know more than me. :D
 

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Here's a reference with some guidelines. I usually prefer to check primary sources rather than secondary ones, but can't because I am in the process of completing a difficult philosophical translation right now :D

From: HIPAA Privacy; Oral Disclosures; Vanderbuilt Medical Center
HIPPAA PRIVACY - Oral Disclosure

LEAVING PHONE MESSAGES - Description:

Phone calls to patients are made to follow up after a visit, to remind them of upcoming appointments, to let them know the result of a test is in, to let them know the prescription order has been filled, or for a variety of other reasons. When the patient is not available to answer the phone call, messages are sometimes left.

Messages are left with someone other than the patient or on an answering machine present the risk that unauthorized individuals are receiving information related to the patient's healthcare directly or by hearing it on the answering machine.

Recommended Safeguards:

§ Appointment reminder messages should be limited to a confirmation of the patient's name, the physician's name, and the date/time of the appointment. No information that may be related to the patient's condition should be left (clinic name, type of procedure, etc.).

§ When attempting to contact the patient to discuss clinical information (i.e. test results, instructions, etc.) the message should only confirm it is from VUMC and leave a name and a callback number.

§ If the clinical communication is urgent, and staff are having difficulty contacting the patient, professional judgment can be used to leave more detailed messages on machines or with family members.
 

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Discussion Starter #9
Originally posted by SylphidesMom@Feb 26 2005, 07:05 PM
Here's a reference with some guidelines.  I usually prefer to check primary sources rather than secondary ones, but can't because I am in the process of completing a difficult philosophical translation right now :D

From: HIPAA Privacy; Oral Disclosures; Vanderbuilt Medical Center
HIPPAA PRIVACY  - Oral Disclosure

LEAVING PHONE MESSAGES - Description:

Phone calls to patients are made to follow up after a visit, to remind them of upcoming appointments, to let them know the result of a test is in, to let them know the prescription order has been filled, or for a variety of other reasons.  When the patient is not available to answer the phone call, messages are sometimes left. 

Messages are left with someone other than the patient or on an answering machine present the risk that unauthorized individuals are receiving information related to the patient's healthcare directly or by hearing it on the answering machine.

Recommended Safeguards:

§  Appointment reminder messages should be limited to a confirmation of the patient's name, the physician's name, and the date/time of the appointment.  No information that may be related to the patient's condition should be left (clinic name, type of procedure, etc.).

§  When attempting to contact the patient to discuss clinical information (i.e. test results, instructions, etc.) the message should only confirm it is from VUMC and leave a name and a callback number.

§  If the clinical communication is urgent, and staff are having difficulty contacting the patient, professional judgment can be used to leave more detailed messages on machines or with family members.
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Gosh, thank you so much for this info. I had tried to find something on the act but couldn't find anything as straightforward as this. So, it just seems to me that they really did have options. If they had been thinking of my feelings and possible anxiety she could have said it was related to scheduling, an appointment, or was not medical related or was not urgent or something else. I would just think medical personnel would be sensitive to patients' feelings.

For those that asked about my gynecologist.... I had gone to his partner for many years and the partner retired so I got this guy by default. He's a very, very good doctor but sort of typical in that he is always sort of rushed and one time I had a test done and he told me to call on Wednesday to speak with him about the results. When I called on Wednesday I was told he was at a medical meeting until Monday! So I had to wait forever for the results. I guess he just forgot ??? Anyway, now when anyone says call for results I always ask what their travel schedule is!

We have a lot of very good ob/gyns in my city (for some reason). I'm still conflicted!
 

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Discussion Starter #10
Originally posted by SylphidesMom@Feb 26 2005, 06:29 PM
I would definitely consider my relationship with the doctor to be my primary focus--a good gyn is hard to find.

Having said that, I can't believe that HIPAA won't allow them to state something like:  we notice that you are due for your regular check-up or something to that effect.  Our dentist and the chiro always do--doesn't HIPAA apply equally to all?

I think the staff handled your situation without any consideration of your feelings.  That alone would make me switch.  I can't stand being treated like a thing or a number.  So many medical clinics do that to patients.  However, if, like me, you are well insured and have an array of choices, I'd say take your business and your money somewhere you'll be treated with kindness and respect.
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Yes, I have great medical coverage. What you say in your 2nd paragraph hits home with me....
 

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Sher,
I can understand your anxiety when you got that message. I would have completely freaked out. The last time I got a mammogram I waited and waited for my Dr. to call. Finally, after a week, I called them and they told me that they couldn't give me any info over the phone and that they would only call if there was a problem and they didn't even know if the results were in. My husband calmly faxed over from his office and requested the results and then HE called me to tell me that everything was fine. So one medical person to another can get the info, but the poor patients are just SOL.

Anyway, it seems obvious that the message could have said "Please call our office to make an appt. for your annual physical" or something else pretty non commital. I do think that the letter from the practice admin. was pretty nice. They took responsiblity for the fact that they were at fault for not generating the usual reminder letter and I didn't think they seemed condescending at all. My advice would be to evaluate your feelings about your physician. If you love him/her then keep going. If you don't really care then maybe its time to look around. Once I was done having babies, I no longer use an OB/GYN. I use an internist who does everything. I've never had GYN problems so feel like the internist looks out for all of me, rather than just one area.
 

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I understand how scary this was for you especially after having a mammogram done. But I would base my decision to leave on how much I like or trust my gynecologist. This is a doctor you don't change easily. I never had that problem with my gynecologist tho. His staff does not call to remind about yearly appointments. They send a note through the mail saying that you are due for your yearly visit. If something is wrong after a test, my gynecologist calls himself ; he does not ask his staff to do it. The nurse will send me the results of the blood and pap smear test either through the mail or by fax, but I asked specifically that they do that.
If you decide to stay with them, I would definately talk to Bettina and also have a word with the doctor itself.
 

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I agree with the others...I wouldn't get too mad at your doctor...but I feel for you! It must have been scary.
I have my obgyn and I will keep her until she retires...

Oh...and I NEVER get any calls about appointments and yearly exams or anything!


~Elegant
 

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Discussion Starter #14
Thanks everyone for your wise counsel. I really appreciate hearing your opinions on this. I still am not 100% sure what to do! But now I have a lot of good advice to help me. Thank again for taking the time to share your thoughts.
 

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Originally posted by Kallie/Catcher's Mom@Feb 27 2005, 11:43 AM
Thanks everyone for your wise counsel. I really appreciate hearing your opinions on this. I still am not 100% sure what to do! But now I have a lot of good advice to help me. Thank again for taking the time to share your thoughts.
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That's what we're here for!!!!
 

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Elegant, LOL
I'm with you. I'm keeping mine until she retires.

Kallie/Catcher's Mom, I just have to ask.... Are you comfortable with a male doctor? I could never do that, not that it's bad. I just get soooooo uncomfortable. Also I don't know how a male can figure us out better than a female. if you know what I mean....
 

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Discussion Starter #17
Originally posted by Lani@Feb 28 2005, 01:15 AM
Kallie/Catcher's Mom, I just have to ask.... Are you comfortable with a male doctor? I could never do that, not that it's bad. I just get soooooo uncomfortable. Also I don't know how a male can figure us out better than a female. if you know what I mean....
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Hi Lani, To answer your question.... When I started going to gynecologists there was hardly a female in practice. I'm in my 50s so that was in 1970... before a lot of you were born! So, that is all there was and what I got used to. I started with my first gynecologist in 1970 and he was the most wonderful man... he retired in about 1989 and I ended up going with his partner, also a man. Before I went with the partner I went to two different women and but didn't stick with them.

One of the women was just so anal retentitve, she drove me crazy. The other had to get a scope to do a simple pap smear! So I went back to the male partner in the group I'd been with.

I'm in a club for women professionals with the best women Gyns in town and really don't want to see them professionally; however, a lot of the women in the group do.

I'm truly OK either way.... man or woman.
 

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I commend you for writing the letter in the first place. I have always told everyone I know that you MUST BE PRO-ACTIVE in your own health care. This means keeping track of when you need to go back to your Doctor. I have all my "yearly" stuff done on my birthday or right around there every year so I do NOT forget!! The letter back from your Dr.'s office was accepting responsibility for the errors involved. Many offices would not even bother to do that. Your choice of Dr's is a very personal one. It's not easy to switch a GYN like you would an Eye Dr.!! I do feel they could of added "this is not an urgent call". That would of put your mind to ease, but the Dr's offices are just SO busy these days as we have more and more Dr's dropping out of health care due to the high malpractice insurance rates, not to mention the "assembly line" care you get as they have to see so many pts. per day to fill their "quota" with the Insurance companies. Health care now days is a tough business. I had a Dr. that I just loved, loved, loved. She is an Internist, she had to move her practice in with another Dr. to keep her costs down. She had been through MUCH with me.....imagine my horror when I received a letter (very cold and impersonal) from her office that stated "Dr. X is restructuring her practice and will no longer be your Dr., you have 30 days in which to find a new Physician, any and all medical treatment must be directed to your new physician, if it is an emergency please seek the services of the nearest Trauma unit or Emergency room". I flipped out, she ended up in an office where the "other" doctor was part owner in a private Lab so my Dr. could no longer order lab testing from the lab that my insurance company covered. I was floored. We are going to be seeing many, many changes in the health care system within the next few years....please remain active in your own health care, look for someone you can trust "for now", but do not get to comfortable with them as they may not be there next week!!
 

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Originally posted by Sisses Momma@Feb 28 2005, 10:04 AM
I commend you for writing the letter in the first place.  I have always told everyone I know that you MUST BE PRO-ACTIVE in your own health care.  This means keeping track of when you need to go back to your Doctor.  I have all my "yearly" stuff done on my birthday or right around there every year so I do NOT forget!!  The letter back from your Dr.'s office was accepting responsibility for the errors involved.  Many offices would not even bother to do that.  Your choice of Dr's is a very personal one.  It's not easy to switch a GYN like you would an Eye Dr.!!  I do feel they could of added "this is not an urgent call".  That would of put your mind to ease, but the Dr's offices are just SO busy these days as we have more and more Dr's dropping out of health care due to the high malpractice insurance rates, not to mention the "assembly line" care you get as they have to see so many pts. per day to fill their "quota" with the Insurance companies.  Health care now days is a tough business.  I had a Dr. that I just loved, loved, loved.  She is an Internist, she had to move her practice in with another Dr. to keep her costs down.  She had been through MUCH with me.....imagine my horror when I received a letter (very cold and impersonal) from her office that stated "Dr. X is restructuring her practice and will no longer be your Dr., you have 30 days in which to find a new Physician, any and all medical treatment must be directed to your new physician, if it is an emergency please seek the services of the nearest Trauma unit or Emergency room".  I flipped out, she ended up in an office where the "other" doctor was part owner in a private Lab so my Dr. could no longer order lab testing from the lab that my insurance company covered.  I was floored.  We are going to be seeing many, many changes in the health care system within the next few years....please remain active in your own health care, look for someone you can trust "for now", but do not get to comfortable with them as they may not be there next week!!

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Gosh, thanks for your thoughts... yes, a "this is not an urgent call' or something like that would have been all I needed. Like I said, what if I had gotten that message when I came home from work in the evening and had to wait until the next day to find out what they wanted. Also, I was hoping that the reply would tell me that they had decided to change their system to add something like that to the phone message.

Yep, I trusted them to let me know when I had an appointment. They used to have a recorded call that would tell me it is time for my appointment. I just relied on them. I was floored to find out it had been two years... it just doesn't seem possible! In a way, I do think it was sort of negligent to change systems and not notify us when we were used to being notified. Even a letter or recorded call to patients saying they had a new system and to be aware that we may not have been notified. I just don't feel they handled all this very well. They disappointed me... after going there since 1970 with just a couple years trying two other docs when mine retired and then back to them. That's a long time at a practice....
 

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I used to see a female GYN and she was awesome, I swore she was gonna be the one to deliver my kids.. I was 18 when I first went to see her and she was so down to earth and ready to answer my questions...


Now I see a male dr at the public health center. He's actually very good, and I'm very comfortable with him... :D

I used to think a male dr would freak me out, but really he's as good as my old GYN was. Once I get health insurance again I'll be back to a GYN search...
 
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