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Thread: Opinions, Please

  1. #1
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    Default Opinions, Please

    I saw my rheumy last week (see my other thread). While I was waiting, a young blond lady helped a very elderly lady with obvious Parkinson's into the office.
    I assumed that she was the daughter, but learned that she was a care-taker. When the doc called the patient into the exam room, she wouldn't allow the younger woman to accompany her. This set off quite a bit of loud complaining. From what I gathered, the daughter of the elderly lady had to work and was counting on the care-taker to ask questions and relay information back to her. The doc kept saying that it was a privacy matter.

    Here's my question. Here at WHL, we often advise others to take someone with them to appointments to be a second set of eyes and ears and to help us to remember things. We tell them to take a spouse, relative or even a friend to do this. Is there a problem with taking a non-related friend along? Is this just a California policy, or is it just this doc's policy?

    I don't have a very high opinion of this rheumy, and I get the feeling that she doesn't like questions from anyone. I also don't think that she wants others to see just how little attention she pays to her patients.

    What do the rest of you think of this?
    Hugs,
    Marla

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    I do appreciate when docs try to protect the patient - sometimes there is a pushy or controlling relative who SHOULD be excluded but the patient does not feel strong enough to do it, and may need the doc to intervene.

    Seems to me the best course of action would be for the doc to say something along the lines of "We need a few minutes to speak privately but we will call you in when we're ready for you" - that would give the doc and patient a chance to speak privately and the doc can ask the patient if they really want the other person there. if they do, it shouldn't matter WHO it is, family or not....they should be allowed in. That's my opinion.

    It could also be that this was a known situation and they had a reason for being as adamant as they were - either because they knew the "helper" was problematic, or because they knew they had to discuss something unusual with the patient.

    Or maybe they were just being jerks, I dunno.

    It's funny, but I just saw the OTHER end of that spectrum - the last time I saw my Rheumy my husband wanted to come. I called the office a couple days ahead of time just to make sure that was okay, and to give the doc a heads-up...they front desk just laughed - the woman I spoke to said "honey, you can bring whoever you want - you can have a party in there - as long as everybody fits in the room!"....

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    When I last saw my RA, here in WA she advised me to bring someone with me, family or friend to ask questions and etc because a patient only remembers a small percentage, a number she gave but I can't remember. Bola often came with me to my appointments especially if I was in a fog...he was very loving like that.

    Perhaps on her medical record it says family only allowed to receive medical info? I have had the question on my five inch thick of forms to fill out...only to be asked the same questions over and over on many sheets..list or check. Then you enter the exam room and the same questions except verbal now.

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    It's very true that I don't know all of the particulars of this case. The elderly lady seemed almost helpless and might have had some dementia, too.
    I really felt that the doc was being rude - she's always very short and rude with me.
    Like Oluwa, I've always heard that you should bring a family member or friend along.
    The caregiver was talking to the daughter on the phone when they left. If I was that daughter, and I was counting on a friend to help my Mother for the day, I would be very upset with that doc.
    Hugs,
    Marla

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    i always take my wife with me.
    i have nothing to hide.

    we also have our daughter go to a counsellor.
    she spends the first part of the visit alone.......
    but we also join in part of the visit.

    i presume the doctor is a #######.

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    If it was ok with the old lady, then it should have been ok with the doctor. Who does she think she is?
    When it comes to privacy issues, it's the doctor who can't tell anybody else without my consent, but I can tell anyone I want.
    She is just a jerk.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    California, specifically, has statutes relative to PHI or Personal Health Information. And, of course, there's good old Federal Regulations governing the release of personal health information under HIPAA.

    In the above instance, I would think that whoever holds the medical POA can appoint someone in their place and stead on a temp basis for the exact reason described, with a signed authorization. Let me check with a privacy officer that I know. This is a great question, Marla!

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    It sounds like it's the doc's policy. It's not a California policy. California's privacy laws leave it up to the patient to designate anyone they wish.

    In my opinion, there are two aspects; the legal side of disclosure and "best practices". The legal aspect is pretty straightforward; the patient has the right to allow anyone to have information relayed to. Providers are usually obligated to abide by the patient's wishes unless there is some valid reason not to. An example would be if the provider felt that disclosure to a certain individual would be harmful to the patient, the provider could "challenge" the patient’s designation. It's generally not a wise (or easy) approach, but the provider technically could refuse to disclose information to a certain individual is s/he felt it was in the patient's best interest or if it was disrupting the patient's care. The provider should be prepared to demonstrate why s/he does not want to abide by the patient's wishes. In extreme cases that have gone to court, the courts typically respect the patient's right to designate anyone as a participant in his/her care. The industry standard is leaning towards "care team" model which heavily relies on involving the patient and/or his/her designee(s) in all aspects of the patient's care.

    If "privacy" were truly the concern, I would think the provider would have spoken privately with the patient and have her document it was okay to disclose to the caretaker. In my opinion, the fact that the provider did not attempt to get the patient's preference in writing either means the provider really was not concerned about privacy OR the patient is not legally competent (i.e.: legal conservatorship).

    What I usually see is providers allow whoever is with the patient to go into the room with them and as long as the guest is not disruptive, most providers don't seem to care who the patient is accompanied by.

    This situation sounds like the doc is using privacy as an excuse not to have "witnesses" like Marla said. That's a huge red flag in my opinion.

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    This is an interesting observation, and an excellent question Marla,

    My sister escorts and represents some of the people under the care of the Veterans home she's the admin at when going to outside appointments, because some of the people there have no family to go to outside appointments with them, and some have limited mental faculties as well.

    I'll ask her the particulars of the laws pertaining to this here in our state, as well as what she knows of the subject overall.

    My own first reaction is that this rheumatologist is yet another less than competent "professional" who thinks that he/she is above the examination and scrutiny of their patients, as well as beyond the scrutiny of that patient's family, friends, and/or advocates. However, this is only my personal opinion based on limited info, and an opinon possibly skewed by my own negative experiences with incompetent specialists.

    I'll post what sis tells me.

    Rob
    Last edited by rob; 06-20-2012 at 06:44 PM.

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    I take care of my 88 yr old grandma (she is not my real grandma, she took care of me when i was younger, and now i feel it is up to me to give back). With that being said I take my grandma on every appt and i am her eyes and ears!!!!! I feel any good dr. would love a family, caregiver or friend to hear and translate the important details.... It's a shame when dr's are not compassionate.
    hugs
    lynday

















    i feel as if

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