When One Health Care Provider Overides the Orders of Another Provider

I was working with a 65 year old female client this week. Her husband was my main source of contact. She is nine years post mastectomy, chemo and radiation for stage 3 breast cancer.

During the past few months she has been having overall generalized body pain, especially in her back. A few weeks ago she developed shortness of breath. Obviously, she was scared to death about a reoccurrence of her cancer.

She had enrolled herself into a new Medicare Advantage Plan this year and had to change her doctors and start her current health journey from ground zero. Over the past few months she was seen by several “new” doctors who were unfamiliar with her medical history.  They ran some basic tests but basically dismissed her symptoms (gaslighting). Her blood pressure was found to be extremely high during one of those doctor visits and she was experiencing severe headaches. That doctor put her on a high dose antihypertensive.

Three days later, on a Sunday morning, she found herself in the emergency room with a very elevated blood pressure, severe headache, vertigo and weakness,  near collapse… in addition to her other on-going symptoms.  The emergency room doctors took good care of her, ordering a battery of scans, MRIs, and assorted blood tests to try and make a diagnosis. They took lots of time with the patient and her husband explaining the tests and how the results of them could help them find a cause for the patient’s symptoms.

These tests were to begin the next day, Monday.

In days gone by, when patients were admitted to the hospital, their primary care doctor would take care of them…assuming that provider had patient privileges in that particular hospital. In today’s health care arena, we now have hospitalists taking care of hospitalized patients. They are providers who generally work twenty-four hour shifts two to three times a week. While dedicated and skillful, they don’t really know the patient, and this can result in lack of continuity in patient care.

Unfortunately, when the hospitalist showed up on Monday morning he told the patient and her husband that he considered the tests ordered over the weekend unnecessary and he was going to cancel them. The husband immediately called me for guidance as to how to best advocate for his wife in getting her the diagnostic testing deemed essential by the weekend medical team.

I told the husband to speak with the nurse manager on the floor and express their concerns about the cancellation of diagnostic testing by the Monday doctor which the weekend doctors thought were essential.

I told the husband if the nurse manager couldn’t help them, he should pick up the patient’s bedside telephone and dial zero for the operator. He should then request to be connected to the nurse manager on call for the entire hospital and have the conversation with that person. And if he didn’t get any assistance from him/her, they should reach out to the doctor in charge of the unit, and then the doctor in charge of the hospital, and then the CEO of the hospital as needed. I told the husband to tell each one of these individuals that “according to the weekend doctors, there were important rationales for doing each one of those tests and now a doctor shows up on Monday who doesn’t know his wife is canceling those tests”. I told him to tell each person he  spoke to that he felt his wife was being gaslighted by the Monday hospitalist, which means he was dismissing the patient’s symptoms. I told him to tell them that you would hold the Monday doctor and the hospital liable should anything happen to his wife because the tests were cancelled.

Ultimately, the charge nurse was able to talk to the Monday hospitalist and talk him out of canceling the diagnostic tests.

An easy fix and a satisfactory ending.

When advocating for a loved one in the hospital, it’s important to partner with the health care team in a positive manner. Staying calm, polite and intentionally focused on the patient’s needs is essential.

Be assertive but not rude. Be persistent but not harassing.

You Have A Voice… Use it!