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Legal Speak

A Messaging Problem

Published March 21, 2013 2:00 PM by Tony DeWitt

Time after time in this forum and everywhere I get asked to speak, I spout the golden rule of medical negligence: people don't sue people they like. 

I also tell people the corollary: If you make people angry, and they don't like you, they have no problem with suing you. In fact, they like it.

I was reminded of this last week when I went into the hospital for cardiac catheterization. As a side note, I think that the choice of wording has a lot to do with how normal people perceive things. Those of us with healthcare backgrounds know, when we hear "cardiac cath" that they'll stick a balloon in our artery and shoot die through it to see if we have perfusion. 

But when we refer to something as a "dye study" we should be mindful that homonyms, words that sound the same but have different meanings, should always be avoided. If you knew they were sticking a plastic catheter into your heart and you had no medical background, the concept of a "die study" would be, well, to say the least, frightening.

The result of my "dye study" was three new stents in my circumflex artery. I now have so much metal in my heart that I have to take a teaspoon of Liquid Plumber every morning at breakfast. But, while the cardiac end of things came off without a hitch, there was a complication.

Specifically (and there is no non-embarrassing way to say this), my urinary catheter gave me a urinary tract infection. Those of you who work in SNFs know these are common and frequently associated with catheterization. You also know they're painful. I assumed mine was normal irritation from the catheter. But when it had not gone away by my first day home, I called the cardiologist to get something for it.

As a general rule, and I am sure there are exceptions, most cardiologists are medical doctors, internists, who have not only completed an internal medicine residency, but have done a cardiology fellowship. Somewhere along the line it is certainly inferable that they learned a thing or two about infections and antibiotics. Here is the transcript of my call with the doctor's nurse:

Nurse: I got your message. Dr. X doesn't treat infections. He only writes prescriptions for cholesterol and cardiac medicines.

Me: Excuse me?

Nurse: You need to see your primary care doctor.

Me: My primary care doctor didn't cause this problem. My cardiac cath, the one your doctor set up for me, that's what caused it. I need to get a prescription.

Nurse: I'm sorry. I can't call it in. He doesn't write them.

Now, that's what was said.  Would you like to hear what I heard?

Nurse: You are completely unimportant to me.

Me: Excuse me?

Nurse: A pimple on my behind rates higher than you do.

Me: My primary care doctor didn't cause this problem. My cardiac cath, the one your doctor set up for me, that's what caused it.  I need to get a prescription.

Nurse: I have to do my nails. Please die quietly and don't call back.

Have I taken some liberties here? Sure. But the issue is that your average Joe, when they have an interaction like this, carry away from it a feeling that they are less important than whatever was on the supper menu that evening. 

Messaging is important. If this was really the doctor's policy he should tell people this up front. In the pre-procedure and post-procedure visits, he should instruct his patient to call the primary care physician for any problems that are not cardiac in origin. 

And Nancy Nurse could have done a lot better too:

Nurse: Thanks for calling.  Do you remember when you were here and we gave you the written instructions for after the hospital visit. We told you in that pamphlet that if you had an issue that wasn't related to your heart or your heart medications that you should call your primary doctor. Do you remember that?

Me: Uh, no?

Nurse: Here's what I can do for you. How about I call Dr. Y's nurse and have her give you a call. Will that work for you?

Me: That would be great. Thank you.

When people feel valued, they are happier with the care, and are more willing to forgive honest, even if tragic mistakes. But make them feel like they're an interruption in your day, and your life is going to get ugly.

More articles on this topic:

Keys to Uncluttered Communication

Resident Engagement

Return to ADVANCE for Long-Term Care Management homepage


posted by Tony DeWitt


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About this Blog

    A.L. "Tony" DeWitt, RRT, CRT, JD, FAARC
    Occupation: Attorney
    Setting: Jefferson City, Mo.
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