Scenario #1: Elderly Patient for a Chronic Disease Visit

Scenario #1: Elderly patient for a chronic disease visit

Hazel is a 73 year old retiree, scheduled to see Dr. Smart for aquarterly hypertension visit. As she pulls into the City Family Care parking area she sees that the only spaces that are available are “doctor only” parking, forcing her park across the street in the overflow lot. Hazel enters the clinic, checks in at the front desk and is instructed to sit in the waiting room. Hazel looks around, the TV is off so she picks up the only magazine a Newsweek from 2008. After a twenty-minute wait, Sally the MA comes and calls out her name, she follows behind Sally as they walk a hurried pace to the exam room. Hazel is asked to get on the hallway scale while the staff person holds her purse and jacket. Sally notes her weight in the chart, takes and records heart rate and blood pressure and leaves Hazel in the exam room. While waiting for Dr. Smart, Hazel who describes herself as “visual,” a list of last month’s blood pressure readings. Dr. Smart enters the exam room, greets Hazel and begins to review her medical record. Dr. Smart then asks Hazel if she has been taking her medication as prescribed, to which she answers “yes.” Dr. Smart then notes that “your blood pressure reading was high today, but it is nothing to be concerned about.” He then gives Hazel a smile, a pat on the shoulder and informs her that he would like to see her again in three months. The next day the office manager opens the suggestion box to find a note from Hazel describing her experience, her concern about her condition and that she is considering looking for a new doctor that will support the care for her condition in a better manner. This is not the first note of this kind that the practice has received. The practice has decided to investigate further.

Scenario #2: Non-native English speaking patientfor a chronic disease visit

Mr. G is a 49 year old horse trainer and breeder. He speaks English as a second language, and while he normally brings his son with him to doctor’s appointments, today he had to make the 40 mile trip on his own. He arrives at the 3rd St. Clinic with complaints of difficulty breathing. After examination, Dr. Rsuggests this may be signs of cardio vascular disease. Dr. Rexplains the condition. Dr. R informs Mr. G to watch for other signs of the condition and to call a doctor if symptoms get worse. Dr. R asks Mr. G if he understands the instructions, to which the patient responds “yes.” Mr. G is instructed to make an appointment to come back next week for a recheck and to discuss symptoms further with his son and for his son to call the clinic if he also has any questions.

Two days later, Dr. R is informed that Mr. G was in the Emergency Department. Upon inquiry it was revealed that Mr. Ghad come down with a sore throat. He remembered that he should call a doctor if symptoms got worse and went to the Emergency Department when he couldn’t find the number for the clinic. After discussing the situation with his son it was revealed that Mr. G never had a breathing problem, but that he only had a sore throat and did not in fact have symptoms of a chronic disease. The practice has decided to investigate further if other patients that do not speak English as a first language have had trouble communicating during office visits.

Scenario #3: Lab result processing

Nurse Robert is feeling frustrated. He has only been working at the Wharton Family Clinic for six weeks and Mr. Andrews is the third patient who never received important lab results. Robert wonders how many other patients might be missing lab results. Wharton Clinics policy is “no news is good news” so if you don’t hear back from the clinic, you should assume your test results were normal. If the results are abnormal, patients are told that their provider will contact them within two weeks. However, Mr. Andrews has very high PSA (Prostate Specific Antigen) results that were taken over a month ago. When Nurse Robert asks his supervisor about the policy she informs him that the process was set up by the process improvement team. She goes onto to explain that reporting all those normal lab results was taking up way too much time, so the all physician improvement team decided on the current policy for reporting lab results. When Roberts asks about abnormal results not getting reported, his supervisor replies, with a roll of her eyes, that she is not sure how that occurs, but that “Dr. Mason isn’t generally flexible with the physicians policies.”

Rev. 11/02/2014