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The Fine Art of Incompetence
Everyone makes mistakes. To err is human. Making a mistake is not incompetence. Repeating mistakes, over and over, and not learning from those mistakes is incompetence. Some people have just taken incompetence to a much higher and more refined level than others.
Today is my day off so I was in line at a large box home improvement store. I brought in a painted, broken piece of baseboard, complete with bent nails sticking out of it, so that I could buy the same type. While I was checking out, the cashier was very troubled by the fact that this piece of wood that I brought from home did not have a price tag.
"Did you bring this from home?" She asked.
"Well, yeah. It old, broken, and has nails sticking in it. Do you sell them like this?"
On Sunday, I had to call the satellite TV tech support because my DVR was not recording the shows that I pre-programmed. My wife went ballistic because Dancing with the Stars did not record. She insinuated the problem was my incompetence - that I had not set it correctly. I dislike calling the tech line, especially on Sundays. I assume (usually correctly) that the newest and least-competent people have to work the lines on Sunday. My heart raced as I navigated the phone tree. Will I be talking to a heavily-accented foreigner who claims his name is Jeff? As a fatalist, I know the person will not be competent, or perhaps I set my goals too high.
We have a very large medical office; many providers, many medical assistants, and many support staff. Some days, it looks (and sounds) like Grand Central Station. We are just ending a very long "cold and flu" season, just in time to start our spring allergy season. Instead of feverish, coughing kids and kids with ear infections, we now have the wheezers and sneezers. Spring break is upon us and nervous parents are bringing in the ill and suspected-ill children to make sure they will be well before going to Disneyland. The busier the office, the more likely mistakes will be made.
Let's start with the front desk and receptionist. Within ten minutes of my arrival, a contrite receptionist will be standing in my doorway requesting a "big favor". Some unknown person apparently made a mistake. Instead of booking the appointment for tomorrow, they booked it for next year (just one number off).
"The patient is here now; you are completely booked. Can you see them?"
"Yes, of course." They always ask me because I rarely, if ever, will turn them away. No matter how busy I am, I can see just "one more patient". This wasn't the patient's fault; it was a bit of incompetence on our part.
An hour later, another receptionist is hanging out by my office, waiting for me to come out of an examination room.
"It is 9:30 and your 8:45 patient just arrived and wants to be seen. They claim that the automatic, appointment-reminder call system told them the wrong time (that really doesn't happen since calls are directly linked to the appointment time)."
If people would just tell the truth, or at least come up with a more creative and entertaining lie, I would be more willing to forgive them. I actually enjoy hearing bogus excuses, though. Over the years, I have heard lots of them. In most cases, failing to make appointments on-time is really incompetence - poor planning.
Now, the medical assistants: Many names sound the same. Yesterday, I saw Caden (age 5) for a physical exam. Caden had gained 30 pounds since his last visit a month ago; grew eleven inches taller. My medical assistant did not seem to notice. Caden was also not Caden; but really Aiden (age 9). Blame it on being rushed, or the noise, or a simple mistake. Or, call it like it is: incompetence. In the scope of things, this is a little mistake in a medical office. There can be big ones, too. We ALL have to check and double-check: comparing names with birth dates and confirming that we do, indeed, have the right person and the right chart.
Before my wife went in for abdominal surgery, I physically wrote her name and the type of surgery she was going to receive ON HER STOMACH. Her surgeon was amused, but at least she didn't get the wrong surgery.
The pharmacist: We use electronic or e-prescriptions (and e-faxes) in our office to limit mistakes. It is now more difficult to give a medication to a person who was allergic to it. People no longer lose their prescriptions on the way to the pharmacy, and of course, druggies can no longer change the amount, say from 10 to 100 pills. We can however fax the prescription to the wrong pharmacy in the wrong state. Every state in America seems to have a town named Roseville and a Walgreens. A slip of the finger could send your amoxicillin to Minnesota.
The patient was sitting there when I sent her prescription electronically. There was confirmation that it was successfully sent. She showed up in the pharmacy about an hour later and was told that no prescription was sent. She called me. I confirmed (again) that I had sent it. Cyber-crap does happen, so I just sent it again. She went back to the pharmacy and was told they never received it. Now, I am mad, so I called the pharmacist personally. It took about 15 minutes for him to get to the phone. I nearly had a nervous breakdown listening to bad music on hold. I told him of the two prior failed prescriptions, and he told me what was happening.
When the pharmacy technicians get busy, they simply remove the paper from the fax machine and allow the fax to be stored in the buffer. That way, when the patient arrives at the pharmacy, they can honestly tell them "they did not get it". As soon as they catch up, or when the next shift is getting ready to come on, they simply put the paper back in the fax and magically, a few dozen prescriptions (including both of mine) come out. I orally gave the prescription to the pharmacist this time.
Twenty minutes later, the patient is on the phone again. This time she is standing in the pharmacy where she is being told A THIRD TIME that they do not have her prescription! No one bothered to even ask the pharmacist in the back if he had it. This is incompetence.
As a medical consumer, it is imperative that you take an active, participatory role in your care. Make sure the prescription at the pharmacy is the same as what your medical provider told you that you were getting. Of course, there is the "generic versus brand name" issue.
"I am going to fax over a prescription for Omnicef."
Of course, when you arrive at the pharmacy, the bottle will say "cefdinir". Unless specified, the pharmacist is obligated to give the generic because it is less-expensive. A quick consultation with the pharmacist will confirm that you did, indeed, get the right prescription. Just like Caden and Aiden, there are many drug names that sound the same, too.
I was re-editing this blog post today before publication and the phone rang. It was my tax-preparer. She said that I apparently gave her a wrong social security number for my wife and the electronically-filed taxes were rejected and that I would need to file by mail.
"You have my wife's social security number. The same one you used last year, and the same one that is on the W2 form. You were the one that transposed one number differently on the 1040 form, not me." Silence followed.
"Yes. I see that is what happened. Thanks." Click. No apology for the mistake. No apology for her lame attempt to shift the blame. I am sure glad that I complained about their increased fee this year to do the exact same job. I guess the more you pay, the less we get.
If one out of four people are incompetent, then think of three other people. If they seem okay, then maybe it is you. Just kidding. Again, everyone makes mistakes. It is quite easy to blame others. It takes an honest person to admit your errors.
Don't just assume because your medical provider has a lot of letters after his/her name, that it automatically means they are always competent. I have been in the medical biz for over three decades and I have seen a lot of mistake; even made a few (little ones) myself. I thank God every day that I have never harmed anyone with a medical mistake -- a record I intend to keep.
It has been said that medical providers hide their incompetencies and bury their mistakes. My personal philosophy was inspired by a book years ago called Kill as Few Patients as Possible by Oscar London, MD, WBD. (Incidentally, the WBD means "World's Best Doctor" - a tongue-in-cheek degree.) There are no such animal as the "best doctor", only the best person.
I will end with Dr. London's (a pseudonym) final words in the book: "Keep out of jails...and hospitals."
Related Topics:
Today is my day off so I was in line at a large box home improvement store. I brought in a painted, broken piece of baseboard, complete with bent nails sticking out of it, so that I could buy the same type. While I was checking out, the cashier was very troubled by the fact that this piece of wood that I brought from home did not have a price tag.
"Did you bring this from home?" She asked.
"Well, yeah. It old, broken, and has nails sticking in it. Do you sell them like this?"
On Sunday, I had to call the satellite TV tech support because my DVR was not recording the shows that I pre-programmed. My wife went ballistic because Dancing with the Stars did not record. She insinuated the problem was my incompetence - that I had not set it correctly. I dislike calling the tech line, especially on Sundays. I assume (usually correctly) that the newest and least-competent people have to work the lines on Sunday. My heart raced as I navigated the phone tree. Will I be talking to a heavily-accented foreigner who claims his name is Jeff? As a fatalist, I know the person will not be competent, or perhaps I set my goals too high.
"My name is Jeff. How can I help you?" (Damn, I knew it!)
"My DVR is not recording shows that are programmed."
"Is it plugged in?"
"You are really good, Jeff. Thank you." (I called back on Monday)
We have a very large medical office; many providers, many medical assistants, and many support staff. Some days, it looks (and sounds) like Grand Central Station. We are just ending a very long "cold and flu" season, just in time to start our spring allergy season. Instead of feverish, coughing kids and kids with ear infections, we now have the wheezers and sneezers. Spring break is upon us and nervous parents are bringing in the ill and suspected-ill children to make sure they will be well before going to Disneyland. The busier the office, the more likely mistakes will be made.
Let's start with the front desk and receptionist. Within ten minutes of my arrival, a contrite receptionist will be standing in my doorway requesting a "big favor". Some unknown person apparently made a mistake. Instead of booking the appointment for tomorrow, they booked it for next year (just one number off).
"The patient is here now; you are completely booked. Can you see them?"
"Yes, of course." They always ask me because I rarely, if ever, will turn them away. No matter how busy I am, I can see just "one more patient". This wasn't the patient's fault; it was a bit of incompetence on our part.
An hour later, another receptionist is hanging out by my office, waiting for me to come out of an examination room.
"It is 9:30 and your 8:45 patient just arrived and wants to be seen. They claim that the automatic, appointment-reminder call system told them the wrong time (that really doesn't happen since calls are directly linked to the appointment time)."
If people would just tell the truth, or at least come up with a more creative and entertaining lie, I would be more willing to forgive them. I actually enjoy hearing bogus excuses, though. Over the years, I have heard lots of them. In most cases, failing to make appointments on-time is really incompetence - poor planning.
Now, the medical assistants: Many names sound the same. Yesterday, I saw Caden (age 5) for a physical exam. Caden had gained 30 pounds since his last visit a month ago; grew eleven inches taller. My medical assistant did not seem to notice. Caden was also not Caden; but really Aiden (age 9). Blame it on being rushed, or the noise, or a simple mistake. Or, call it like it is: incompetence. In the scope of things, this is a little mistake in a medical office. There can be big ones, too. We ALL have to check and double-check: comparing names with birth dates and confirming that we do, indeed, have the right person and the right chart.
Before my wife went in for abdominal surgery, I physically wrote her name and the type of surgery she was going to receive ON HER STOMACH. Her surgeon was amused, but at least she didn't get the wrong surgery.
The pharmacist: We use electronic or e-prescriptions (and e-faxes) in our office to limit mistakes. It is now more difficult to give a medication to a person who was allergic to it. People no longer lose their prescriptions on the way to the pharmacy, and of course, druggies can no longer change the amount, say from 10 to 100 pills. We can however fax the prescription to the wrong pharmacy in the wrong state. Every state in America seems to have a town named Roseville and a Walgreens. A slip of the finger could send your amoxicillin to Minnesota.
The patient was sitting there when I sent her prescription electronically. There was confirmation that it was successfully sent. She showed up in the pharmacy about an hour later and was told that no prescription was sent. She called me. I confirmed (again) that I had sent it. Cyber-crap does happen, so I just sent it again. She went back to the pharmacy and was told they never received it. Now, I am mad, so I called the pharmacist personally. It took about 15 minutes for him to get to the phone. I nearly had a nervous breakdown listening to bad music on hold. I told him of the two prior failed prescriptions, and he told me what was happening.
When the pharmacy technicians get busy, they simply remove the paper from the fax machine and allow the fax to be stored in the buffer. That way, when the patient arrives at the pharmacy, they can honestly tell them "they did not get it". As soon as they catch up, or when the next shift is getting ready to come on, they simply put the paper back in the fax and magically, a few dozen prescriptions (including both of mine) come out. I orally gave the prescription to the pharmacist this time.
Twenty minutes later, the patient is on the phone again. This time she is standing in the pharmacy where she is being told A THIRD TIME that they do not have her prescription! No one bothered to even ask the pharmacist in the back if he had it. This is incompetence.
As a medical consumer, it is imperative that you take an active, participatory role in your care. Make sure the prescription at the pharmacy is the same as what your medical provider told you that you were getting. Of course, there is the "generic versus brand name" issue.
"I am going to fax over a prescription for Omnicef."
Of course, when you arrive at the pharmacy, the bottle will say "cefdinir". Unless specified, the pharmacist is obligated to give the generic because it is less-expensive. A quick consultation with the pharmacist will confirm that you did, indeed, get the right prescription. Just like Caden and Aiden, there are many drug names that sound the same, too.
I was re-editing this blog post today before publication and the phone rang. It was my tax-preparer. She said that I apparently gave her a wrong social security number for my wife and the electronically-filed taxes were rejected and that I would need to file by mail.
"You have my wife's social security number. The same one you used last year, and the same one that is on the W2 form. You were the one that transposed one number differently on the 1040 form, not me." Silence followed.
"Yes. I see that is what happened. Thanks." Click. No apology for the mistake. No apology for her lame attempt to shift the blame. I am sure glad that I complained about their increased fee this year to do the exact same job. I guess the more you pay, the less we get.
If one out of four people are incompetent, then think of three other people. If they seem okay, then maybe it is you. Just kidding. Again, everyone makes mistakes. It is quite easy to blame others. It takes an honest person to admit your errors.
Don't just assume because your medical provider has a lot of letters after his/her name, that it automatically means they are always competent. I have been in the medical biz for over three decades and I have seen a lot of mistake; even made a few (little ones) myself. I thank God every day that I have never harmed anyone with a medical mistake -- a record I intend to keep.
It has been said that medical providers hide their incompetencies and bury their mistakes. My personal philosophy was inspired by a book years ago called Kill as Few Patients as Possible by Oscar London, MD, WBD. (Incidentally, the WBD means "World's Best Doctor" - a tongue-in-cheek degree.) There are no such animal as the "best doctor", only the best person.
I will end with Dr. London's (a pseudonym) final words in the book: "Keep out of jails...and hospitals."
Related Topics:
- WebMD Video: How Doctors Can Learn from Medical Mistakes
- What You Can Do to Prevent Medical Errors
- Help for Medical Billing Errors
- Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
- Living Better Newsletter - Wellness news to keep you healthy and strong!
Labels: medical practice, mistakes
3 Comments:
I had surgery last summer and before I left the house I wrote on the hand I was having surgery on. I wrote, "This one!" on it. Before my surgery my doctor came in and laughed at it, but also put his initials on my hand so he also knew which one it was on.
I've had two surgeries in recent years (breast and wrist) and both times I've been instructed by the pre-op nurses to write NO on whatever side was not to be worked on. I guess it worked, but I also think that both my surgeons were far from incompetent.
My mother went in for surgery. The nurses kept asking her what her name was. After about an hour of that, we learned that they had mixed up her records with another patients and had scheduled her for prostate removal.
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