EPtalk by Dr. Jayne 5/4/23

I was back in the patient trenches this week, having my regular trip through the scanner to determine whether the next six months will be smooth sailing or something else entirely.

What I didn’t plan for was a bumpy preregistration and appointment confirmation process that was scheduled to occur while I was supposed to be off the grid enjoying the outdoors. I just happened to be in cell phone range when the first call came, asking if I had time to complete preregistration. All of the questions I was asked to answer or confirm could have been easily served up as part of a patient questionnaire via the patient portal (as they are when I see the surgeon who is part of the same institution) and could have been sent well in advance of the procedure.

About 20 minutes later, a call came in from the radiology department. This one was a recording, and my Google Assistant picked it up without me realizing it. I had pulled out my phone to check the weather forecast and noticed the call already in progress and recognized the hospital prefix and picked it up. I had to listen to the recording loop through and could finally confirm my appointment. Again, this could have been done through email and/or a patient portal message.

Still, I was left wondering what would have happened had I been truly off the grid as planned? Would they have canceled my appointment, which had been painstakingly scheduled six months in advance and for which I had canceled and rescheduled work meetings? Or would they have accommodated me if I rolled in without confirming? We’ll never know.

Even with that pre-confirmation, things were not smooth on arrival. When I reached the registration desk six minutes before my allotted arrival time),I had to stand there for a few minutes while the registrar copied my details (first initial, last name, time of study, type of study) out of the computer and onto a little sticky strip of paper.

She phoned back to a registrar, who came out and picked up the sticky strip, then hustled me back to the registration area where she rushed me through the process saying, “we can’t have you being late to the waiting room.” Mind you, it was just now my arrival time. She then stuck the paper strip to a notebook in her work area, asked me to confirm my name and DOB, and then asked me to sign on an e-signature pad without even telling me what I was signing. According to the text at the top of the pad, it was my consent for treatment, but I was never offered a copy or advised as to what I was signing. As a physician I know what’s in a typical consent, but the average patient doesn’t, and either way, the consent is invalid unless a patient actually reads it.

From there I was led down the hall at a rapid clip to the appropriate radiology sub-waiting room, where I was handed the proverbial clipboard and asked to complete three sheets of questions, none of which were even remotely populated with my information. As a CMIO, I know it’s entirely possible to generate forms that already have key patient information on them, and for the organization to continue to make the patient print their name, date of birth, and Social Security number on each page is just poor patient experience.

After filling out loads of information that was already in the EHR, I turned in the clipboard and proceeded to sit for a full 10 minutes before I was taken to the changing room. I had enough time to notice the trash under the chairs in the waiting room, and since I was one of the first appointments of the day, it was likely from the day before.

In the changing room, in addition to some fantastic gowns, I was greeted with dust bunnies the size of a plum that had probably been there for several days based on the look of them. I know that all organizations are struggling with retaining lower-wage workers such as housekeeping staff, but I had to ask myself if the president/CEO of the hospital or the members of the board would be proud of their facility. For an institution with billions of dollars in the bank, maybe they could loosen the purse strings a little bit to help recruit and retain staff.

Fortunately, the clinical staff was outstanding. It was one of the best IV starts I’ve had in a long time, and a friendly radiologic technologist had the positioning process down to a fine science. She also honored my request to sleep through the procedure. I’ve had it enough times that I don’t need to be warned every time a new sequence starts, and given the early test time, I was grateful to grab some extra shuteye before heading back to work. At least this time they subsidized the first $1.50 of the parking fee. I always find the idea of paid parking at a world-renowned cancer center to be repugnant when the organization is sitting on a Scrooge McDuck level of reserves.

I usually get my results within 24 hours, but this time it took two full days, which was somewhat agonizing. When the patient portal notification finally came through, I discovered that my biometric settings no longer worked, and the hospital wanted me to log in using my password and then re-enable biometric authentication. Having been a biometric user for years, I didn’t have my password saved within my password manager, so that was a race to try to get the results before going to my next meeting. I was surprised to see that the results had been reviewed by a provider prior to release (usually they release directly) so I’ll have to ask my clinical informatics contacts at the institution what the story is with all the changes.

Although the process was frustrating, at least it took my mind off the other frustration of the week, which involved organizations that I spent a substantial amount of time with at ViVE who have yet to follow up. I’ve got money to spend and time to dedicate to these particular projects, but my patience is flagging. I sent a last round of emails, so we’ll see who responds and which project will get to start first. The others may just have to wait.

Have you had any recent patient adventures? Were they positive or negative? Leave a comment or email me.

Email Dr. Jayne.