I have spent many hours in hospital ERs, medical floors and waiting for surgery results with clients and their families. I have experienced the different cultures of hospitals, their staff and how patients and families are treated. But the one thing I don’t think I will ever get used to is how territorial and controlling the attendings, residents and hospitalists are of their domains.
When I go the hospital, I have to remind myself I am walking into what feels like a foreign country. I feel like I need to bring my passport and have a visa in order to get past the many barriers. Each hospital has its own system, rules, regulations and language. Even the laws designated by the federal or state governments, like HIPAA, are tweaked by the individual institutions.
I had a family tell me they wanted a second opinion on the possibiity of a cancer recurrence. Although my client was not in for cancer, the family felt it was prudent since she had several recurrences over the last nine years. The current medical course was undefined. They had spoken with the client’s oncologist at Dana Farber and she felt it was reasonable request. But she could not just come and do a consult. In essence, she had to be invited by the attending, even though the oncologists had priveleges at the hospital.
The family approached the resident to ask the attending. The attending said no. He didn’t think it was necessary. The son of my client called the oncologist, who said, it is the way of the hospital. Attendings overseeing the patient have ultimate control of the medical course including all consults.
So what can the patient’s family or advocate do to get, what they think, is in the best interest of the patient? The oncologist told my client’s son, push back. Continue to insist, you want the consult until the attending is up against the wall. I was surprised this was the advise of another medical professional. Apparently, even when you are reknowned in your field, it can be difficult to get invited in to particiapte in the treatment plan.
In this situation, the oncologist only wanted to verify there wasn’t another cancer happening. The attending was vehement in dening the oncologist an official consult. The oncologist, luckily, was a part of the system and could view some of the records and tests.
If the attending had continued to refuse, I would have gone to the medical director and/or the director of patient relations. There was really no medical reason to refuse the consult, given my client’s history and onset of current symptoms. Second opinions are vital and helpful. Why not include the experts?
My best advise is don’t be surprised when your request for a test or consult is denied. Don’t let it stop you from asking again. When I speak with the attendings, I try to lay out the reasons quickly and logically. I also ask them to tell me why they are refusing medically. It certainly is hit and miss. My clients/families often are afraind to ask a second time in fear of irritating the attending. If you say it respectfully and sincerely, the staff will react in the same way.