Preparing for a (Gulp!) Colonoscopy: What It Says About Our Healthcare System

As of November 30, I am now, as my gastroenterologist puts it, 39 + 11 years old. You know what that means! So, a couple of weeks ago I called his office to make an appointment.

I would have preferred to simply make the appointment online or even e-mailed the office, but since the practice didn’t offer this, I fought my phonaphobia and punched in the numbers. Of course, I went through five prompts before getting a live person and was put on hold for a few minutes. About 10 minutes later, I finally had my appointment.

I was told to arrive at 2:30 p.m., which I dutifully did. Then the receptionist gave me a stack of paperwork to complete. And a pen.
Among the information I had to provide:

• My husband’s Social Security number, since our insurance comes courtesy of his job. Not sure why this was needed, since the receptionist made a copy of my insurance card, which has all pertinent information on it. Not to mention that in this day and age of identity theft, I don’t like giving out Social Security numbers to anyone. But the last time I refused to provide a Social Security number at a doctor’s office, the doctor refused to see me. Keep in mind that there is no legal requirement to provide your SSN to a medical office, but, at this point, I just wanted to get the appointment out of the way. So I wrote it down.

• A list of medications I’m currently taking and a recent medical history. This information is in my online medical chart, which is maintained by the very hospital where this doctor practices. But guess what? The doctor’s computer system and the hospital’s computer system don’t talk to each other. The doctor can access my online medical record from the hospital system, but I guess it never occurred to him to have this done before I came into the office so his staff could have already updated the medical record in his system.

• My address and age. Um, isn’t this on the driver’s license that you also copied?

• A HIPAA form outlining my privacy rights and listing who can have access to my medical information. I put down my husband’s name. I did not, however, put down the names of the receptionist and the medical assistant, who now have access to my medical information.

At 3 p.m., the medical assistant called me in. She proceeded to ask me the very questions I’d answered on the medical history form in front of her. She then manually entered the information into the computer. It took about 15 minutes.

At 3:25, the doctor entered. We talked for about 10 minutes, during which time I learned that the medical assistant had written my weight incorrectly (she made me 10 pounds heavier, which did not endear her to me). And although I told her I had some pain in my lower right quadrant, she wrote “lower left quadrant.”

The doctor did a quick exam, explained the prep for the, um, procedure, wrote me a prescription, and said he’d see me after the holidays. He handed me a piece of paper with the prep directions on it.

It was now 3:40. I sat in the room another five minutes before the medical assistant escorted me to the hallway and told me to wait for the scheduling person to schedule my procedure. Said person was on the phone. For about 10 minutes. Finally, she called me over, and we scheduled the procedure. She handed me a piece of paper with more instructions.

I left the office at 4 p.m., an hour-and-a-half of my workday down the drain. Why, I want to know, couldn’t I have entered my information online directly in my chart? Why couldn’t I have booked my appointment online for both the pre-visit and the procedure itself? Why did the medical assistant get two very important pieces of information wrong? And why did my instructions come only on paper? How about an app for my smart phone or tablet explaining not only the procedure, but providing the instructions so I can refer to them whenever I need them rather than searching my house in three weeks looking for those two pieces of paper?

This was a simple doctor visit for someone who wasn’t sick. Just consider the waste and errors that result when something serious is going on.

The Institute of Medicine estimated in its recent report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, that we waste at least $340 billion a year due to inefficiently delivered services, including operational inefficiencies at “care delivery sites” (ie, doctor’s offices and hospitals) and excess administrative costs.

Add in the waste from providing unnecessary or inappropriate care, not providing recommended preventive care and screenings and prices that are simply too high, and the Office of Management and Budget estimates that healthcare waste exceeded the 2009 budget for the Department of Defense by more than $100 billion. Keep in mind that’s while we were fighting two wars.

To put this into perspective, the IOM noted, “Health care waste also amounts to more than 1.5 times the nation’s total infrastructure investment in 2004, including roads, railroads, aviation, drinking water, telecommunications, and other structures.”
If we cut out this waste, we could provide health insurance coverage for more than 150 million workers (paying both the employer and employee contributions), which exceeds the 2009 civilian labor force.

Or, we could use that waste to pay the salaries of every firefighter, police officer, and emergency medical technician in this country for more than 12 years.

It might not seem that the 75 minutes of wasted administrative time in the doctor’s office amounts to much. But multiply that by the sheer size of our healthcare system and you start to see the problem.

In my next post, I’ll tell you how some hospital systems in the United States are attacking and eliminating this waste and, in the process, providing better, more cost-effective care.

11 Responses to “Preparing for a (Gulp!) Colonoscopy: What It Says About Our Healthcare System”

  1. Time for Healthcare Providers to Act Like La Guardia Airport | Musings on Medicine and the Health Care System

    […] I truly believe we’re moving in this direction; indeed, I do have an app on my phone that contains my medical record. However, that record is only for my primary care physician and any visits I make to facilities within the  hospital network that owns his practice. It doesn’t integrate with my gynecologist’s records or contain images from my colonoscopy last year. Nor can I access records from either of those two specialists electronically (you can read more about my frustrations with my gastroenterologist here). […]

  2. Brian August

    No to miss the bigger picture of this post, but the social security number gives the doctor a better chance of collecting on delinquent accounts. While it is not required and for privacy, I understand the concern about putting it on paper, but it is one of the best tools for combating the serious issue of patient non-payment. You may choose not to go back to a doctor that asks for it, but you could be giving up a great doctor who is only trying to get paid by patients that probably aren’t you. The problem is – (s)he doesn’t know if you will pay your bill or not.

  3. Amy Korn-Reavis

    The fact that if you did not come in and make that visit that could easily have occurred through online and on the day of the test, the insurance company would not pay for the procedure is part of the issue. Or if you are going for a well woman visit you cannot have your yearly physical done at the same time because again the insurance company would not pay for the test is one of the issues with healthcare overall. It is just one of the symptoms.

  4. Richard McCrone

    Having worked for the Health Care Organization that developed and used the Electronic Patient Record, I find it mind blowing how the medical system in the United States has fought using the electronic medical record. I cannot believe that active resistance is not required to continue the state of chaos so widely found in healthcare delivery. Why do people not steal ideas that so clearly work?

  5. Susan Kuhn

    Deborah! I loved your article!

    I can relate to your experience….although mine is with my child’s pediatrician. EVERY time I go to my children’s pediatrician, the office staff make copies of my insurance cards and I have to sign a sheet that tey print out EVERY time to confirm the insurance info is correct. My kids’ medical file is about 2″ thick and they have no major medical conditions! I want to scream “tree killer” but don’t want to frighten the children and parents in the waiting room! I have commented (politely) several times that they need to convert to electronic medical records since they are affiliated with a local hospital and they told me that since they are the largest group practice in the hospital system, they will be the last to get EMR as the IT guys want to make sure all of the “kinks” are out of the system. I bought that story 3 years ago, but 3 years later, and no EMR!

  6. Maija

    Good points, Debra. Whenever information is entered manually, by the assistant (or by the patient, for that matter), the possibility of error arises. How much better it would’ve been if the office had had access to your online record and just reviewed it with you for accuracy.

    And imagine a link to a patient education website that displays a video of a patient going through the procedure, plus an animation of the prep process, so that patients understand the relationship between a “good prep” — a thoroughly cleaned out colon — and the accuracy of the findings. If the gastoenterologist can’t see the colon wall, ALL that time and money will have been wasted, and the procedure will have to be repeated.

    At my most recent colonoscopy, the recovery nurse made a major patient ID mistake. She gave me someone else’s results, someone else’s bag of clothing, and pointed out the wrong husband in the waiting room. Something in the hospital’s system is making such serious mistakes possible.

    Yes, there are major problems. But it’s important for patients and providers to be allies and not adversaries as we work together to fix it.

  7. Dan Benau

    Debra: Much of what you’ve written underscores the need for the electronic medical records mandate. I can fill in the manual forms well enough, but the average patient finds it difficult. Information can get lost or forgotten or transcribed in error. In a single-record system, different physicians become an accuracy safe-guard rather than yet one more point of error. I understand the concerns of privacy advocates regarding the sanctity of individual records, but I also don’t want the following epitaph on my tombstone: Died of inaccurate medical record, now in permanent privacy.

  8. George Burns

    Kurt: She is 39+11 which = ?
    Most people are not covered by Medicare, so the MCare number issue is irrelevant.

    Could this sort of response be one of the reasons for the chaos?

  9. Kurt Ullman

    The SSN is largely there because (Congressional mandates not withstanding) the SSN is also your MCare number. I always leave it blank at the outset and then fill it in if the doc raises a stink. (And then never go back to the doc again)

  10. Dawn Ann Farnin

    I had to chuckle at your frustration, Debra, because I experienced the very same hair-pulling moments a few weeks ago during my 5 year colonoscopy screening appointment and procedure. I wrote a narrative regarding the story because I wanted to share with other people like myself who are their own healthcare advocates; I have a history of cancer in my family).

    The main reason for my writing is that as soon as the doctor walked into the room, he shook my hand, sat down, crossed his arms and said: “what are you here for”…..after he ‘gifted me’ a few minutes of his time and told me I was ridiculous for reading anything related to lower GI issues *was experiencing severe lower right quadrant pain) because I was ill informed, I wanted to smack him upside the head (ok…that is a midwestern saying and meant to be tongue in cheek). So, I walked home because I could not get a cab and for every step I took on my long and cold trek home, I kept asking myself how I can advocate for everyone else BUT me? I decided that I needed to practice what I preach and when I got home, I called up his nurse and explained that I didn’t like the way he treated me, and that as a patient, I wanted to have a better experience down the road and had her switch doctors/teams. A few weeks later they obliged but the initial in-office consultation you discuss, Debra, also made me uncomfortable with the whole time-consuming process and unorganized fashion of how the office ‘managed’ patients. It may be routine to all of the staff but it wasn’t for me and I wanted a little more compassion and understanding of my needs and concerns. I didn’t want to write about the actual procedure (another nightmare) because I did not want a single person to shy away from gifting him or her 5/10 year lower GI screening. The bottom line in our current health care ‘system’ is not about patient care (of our time, money, resources, emotions, and more) but of their bottom line. So, it isn’t always pleasant ‘getting there’ but it is important to make sure YOU reach your own destination by picking your own course. Hope all turned out well for your procedure, Debra!

    • Debra Gordon

      Thanks, Dawn! I’m actually writing a book called “Patientzilla: Get the Healthcare You Want, Need and Deserve,” that will, hopefully, teach us all how to take back control. Happy New Year!

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