When You Hit The Wall

Dealing with Doctors - January 31, 2013

When dealing with a major health issue, one thing you can expect to happen from time to time is difficulty in dealing with the medical bureaucracy. Hospitals, clinics, and physician offices are no different than any other large institutions in our society. In spite of the best intentions of all the dedicated individuals who work in healthcare, you can expect breakdowns and problems to occur. Sadly, this happens often in our modern lives, but when it happens while you are dealing with a serious illness the stress and frustration is often far worse.

When my husband was sick, we were lucky to experience excellent care and good customer service most of the time. However, there were a few times when we faced a real bureaucratic nightmare. One incident was particularly memorable; my husband was admitted to the hospital at a time when he could not eat. He received all of his nutrition through TPN which is an IV that is administered overnight while the patient sleeps. He had premixed bags of liquid nutrition that were delivered to our home from a special pharmacy. However, on this particular day he was admitted to the hospital around 3:00 pm. The pharmacy in the hospital would not make him a TPN prescription because it had not been ordered before 1:00 pm, which is required by hospital policy. The hospital also would not allow me to bring him a TPN bag from home, because that was also against hospital policy. We were told there was no possible way he could get TPN and therefore ANY nutrition for more than 24 hours.

The story does have a happy ending and this experience taught me some important tricks for dealing with these types of bureaucratic problems. First, we asked to speak with the charge nurse. She was sympathetic but insisted nothing could be done. It was infuriating but I took a deep breath and got my notebook out. I asked her to give me her complete name and job title and then asked the same for her direct manager as well as the pharmacist involved and the pharmacy manager. I calmly explained that I needed this information for the complaint I would be filing with Joint Commission, the agency that regulates hospitals. I also told her that I would be posting this story on the Facebook page for the hospital and Tweeting about it. I asked her if she could explain to me in simple words why my husband should be without nutrition for 24 hours so I could, word for word, write an accurate complaint. She then asked me to wait while she called the pharmacy again. After a few minutes, the nurse returned and told us that my husband's TPN would be delivered within an hour.

Here are some tips that I have learned when you run against a bureaucratic wall.

Try to Keep Calm:
This is much easier said than done but it is critical. When the health and comfort of your loved one is at stake it is understandable that you might be snippy, or raise your voice in frustration or otherwise become upset. Unfortunately, if this happens the staff likely will tune you out and stop listening. If necessary, step away for a few minutes and walk around until you are calm. Then call back or return with a fresh approach. It can make a huge difference in your ability to be heard and therefore resolve the problem.

Take Good Notes:
I can't emphasize this enough. Every time you call or visit a department in any facility and talk to someone, ask for their name and title and jot down a few notes of your conversation. This may seem tedious and/or unnecessary but you will find that being able to recall the date and person you spoke with will be invaluable in getting problems resolved. There were several times that I was able to get charges removed from a bill or an appointment changed simply by being able to recite the name and day that I spoke with someone previously. It really is surprising how powerful having that kind of detailed information can be.

Be Persistent:
Don't just accept the word of one person that "nothing can be done". Ask to speak with a supervisor or manager. It may take several calls or you may have to wait some time to speak with them, but you will often find that if someone with a higher level of managerial authority becomes aware of the problem they can help resolve things more quickly. The consistently squeaky wheel really does get the grease most of the time.

Let Them Know Your Plans:
If the situation is serious you may want to file a formal complaint with the facility management and/or a regulatory agency. Let the individual know your plans to file a complaint but do not use this as a threat. Simply inform them in a clam manner that you will be doing it and that you are getting full documentation so that your report is accurate. You must be prepared to actually file the complaint, do not make empty threats.

Use Social Media:
Sometimes sharing complaints through social media can be more effective than filing a formal complaint with a regulatory agency. Many facilities are aware of the power of social media and fear bad press. Again do not make empty threats and always share accurate information.

Acknowledge When Things Go Right:
My husband was admitted into the hospital more than a dozen times throughout his treatment. We received a patient satisfaction survey every time and we filled it out every time. There were also a few times that I asked to speak with the charge nurse or department manager then told her/him how pleased we were with the staff. People rarely take time to let management know when things are done right and they appreciate the feedback. They may also remember it later if you are complaining when something goes wrong.

Most of the time you will encounter positive, helpful people in the medical field. Remember that most people want to be helpful and to give good service to customers. And on those occasions when they can't due to bureaucratic rules you will find that being calm, persistent and detailed can really help you get through it.