Playing Defense: Basic Training For Patients

By Paul Goldfinger, MD, FACC

“A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient.” (Wikipedia)

Normally, when we think of “defensive medicine” we think of doctors ordering needless tests in order to avoid malpractice suits.

But I’d like to point out another kind of defensive medicine — the kind that requires patients to assert themselves as they navigate the minefield of modern healthcare.

Our idea is to establish the Tropicana Medical School for Patients — Online Campus. We will present a series of sample cases that illustrate how patients can influence the quality of their care. Some will be actual cases and some will be fictitious, based on reality. You can even send us examples but try to keep it all simple — make one or two points at a time. Here is an example:

TMS Case Study #1: A middle-aged man with chronic asthma takes medication for it. He sees a pulmonologist regularly and has flare-ups on occasion. When he has flare-ups, his doctor almost always treats them the same way, and early intervention prevents worsening.

He gets a cold and then he is awakened from sleep with asthma. He uses his inhalers, but the next morning he is worse, and he knows that he needs a medical intervention. He calls his pulmonologist, but his doctor is off. The person answering the phone says, “The covering doctor will call you back, but he will make those calls late this afternoon.”

The patient says OK, but his condition deteriorates later in the day, and he winds  up in the ER.

Analysis:  This patient was right to call his doctor that morning. If  the covering doctor had called back quickly, more intense at-home therapy might have stopped the cycle, as in the past, and stabilized him without the ER visit.

Ideally, the doctors’ office should ask the patient to come right over and see any of the group’s physicians. Physicians should always try to find ways to help their patients receive care without going to an ER.  Refusing a sick patient because the office schedule is full is an ethical failure.

Lesson: Sometimes patients must be demanding. This man should have asked to be seen that morning in the office. If the office refused to see him, then he should have insisted that a physician call him back immediately. If that call-back doesn’t come within an hour or so, he would do well to go the ER (or a reputable urgi-center) to prevent the situation from spiraling out of control.

Subsequently the patient should complain to his doctor about what occurred and ask for a strategy that can be implemented as needed at home to reverse a worsening of the asthma. The doctor should provide the needed prescriptions and guidelines in writing, in advance, for when the asthma acts up again, along with written instructions on how to proceed if home therapy isn’t working.