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Posted by on Mar 15, 2019 in Bioethics, CRPS / RSD | 0 comments

How not to reschedule (15.03.2019)

How not to reschedule (15.03.2019)

Today’s post is a lesson in how not to manage patient care. This example isn’t from an overburdened hospital, or a publicly-administered healthcare institution. It’s from a privately-owned ‘Physiotherapy and Wellness Center’.

Their website promises, in part:

“we focus on all aspects of your wellbeing, physical and mental… Integrity, Results and Client Experience. We make it a priority to deliver on our promise. Our focus is on helping you meet all of your therapeutic, physical and lifestyle needs.”(1)

I’ve been a patient at this clinic for several years, as it’s located almost directly between my home and my workplace. First for adhesive capsulitis (frozen shoulder), now for my current chronic pain condition – a rare disease.

My treatments at this centre have included physical, massage, and other therapies, as well as medical follow-up; my own family physician works at this clinic, from time to time.

It’s not unusual, in this area, for a private physiotherapy centre to offer medical appointments. In most cases a family physician will work at such a clinic for a few hours each week, or perhaps one day a month, to follow the patients treated there.

Some clinics have specialized sports medicine clinicians, other might have geriatricians – depending on the patient population of the specific private facility.

The concept of an occasional on-site physician allows patients to obtain a medical diagnosis of their injury or condition, within the centre. If necessary, referral for diagnostic testing can be issued.

And, of course, medical treatment (e.g. injections) is provided on-site and required medication can be prescribed. The physician can also – with the patient’s permission – provide treatment notes to the clinic’s therapist(s) treating them.

This approach helps to ensure that any therapy (physical, occupational, or other) provided at this type of private clinic is medically appropriate for the patient’s injury or condition.

These private clinics exist largely because, in Québec, physical, occupational, and other such therapies are not covered under our public health insurance program – unless they’re provided within a hospital or government-funded healthcare establishment.

In contrast, the fees to consult a physician at one of these private centres are covered by our provincial health insurance plan. This billing structure doesn’t make sense to many outside of our province, nor does it seem reasonable to many here.

This has created an environment in which medically-necessary physical therapy is provided only to certain patients – those who can afford it. The website of this particular ‘Physiotherapy and Wellness Center’, for example, lists their rates for physiotherapy at: $95 for a 60-minute initial evaluation, $95 for a 45-minute follow-up treatment, and $80 for a 30-minute follow-up session.(2)

These fees can be prohibitively expensive for many individuals, particularly for retirees living on fixed and limited incomes.

My case & costs might be extreme, in that I was diagnosed 3 years ago with a rare disease for which “Physical therapies should be the mainstay of treatment and these include desensitization, restoration of range of motion and strength of muscles in the affected extremity”.(3)

The last time I checked, for the period from May 2016 to about August 2018, I’d spent well over $20,000 on physiotherapy treatments at this clinic. And these treatments have continued. All for Complex Regional Pain Syndrome (CRPS).

These are out-of-pocket costs, although I am refunded $1,500 per year by my group insurance. Most retirees, and many others, aren’t even able to recoup this small fraction of the overall costs of physical therapy. The same holds true for occupational therapy, another treatment that can help seniors live independently.

It’s fair to say that, having paid well over $20,000 to this private clinic to-date, I expect a reasonable level of the “Client Experience”(1) promised on their website. Given that I started with the phrase “Today’s post is a lesson in how not to manage patient care”, you’ve probably guessed that this promise was not kept.

Although I’d continued working full-time despite this disease – since my diagnosis in May 2016 – new symptoms arose at the end of 2018. My disease progressed from the ‘warm phase’ to the ‘cold phase’, and I had no choice but to accept a temporary medical leave.

So since Friday December 21st I’ve been on short-term disability (STD) leave, working to improve my symptoms enough to go back to my job. What am I doing to that end?

First off I’m trying a new experimental product, as a research participant in a clinical trial being conducted within the hospital at which I receive treatment for CRPS. It’s a strange feeling, after having managed a research ethics board for years, to be a patient/participant myself!

If the clinical trial isn’t successful in addressing my CRPS ‘cold phase’ symptoms, surgery is one of the options that my multidisciplinary medical team is considering. Although some of my newest CRPS symptoms include difficulty concentrating & focusing, I’m trying to read research results of this type of surgery specifically for my rare disease.

And in case we opt for the surgery, I’ve been doing a significant amount of exercise and trying to lose some weight – because this could help shorten my post-surgical recovery and rehabilitation period.

My family physician and I also set some daily recovery goals at the start of my short-term medical leave, and I’ve been spending a lot of time on these – each and every day. And, of course, I have regular follow-up appointments with him – in addition to all my appointments with my multidisciplinary hospital team.

If you’re familiar with health insurance plans, you’ll understand that there are forms to be completed – and deadlines to be met. Any failure to submit an appropriately-completed form, by a required date, can result in the suspension of short-term benefits; an interruption in my payments-as-salary.

When I last saw my family physician, on January 17th, he completed a STD form for my insurance. In the space for our next follow-up appointment, he wrote March 14th; today’s date. Then, at the end of my appointment, he walked to the front desk with me to be certain that I was given a follow-up appointment on the date he’d written on the form.

My March 14th appointment was in the evening, so when I sent in the STD form I advised them that they wouldn’t receive an updated form (hopefully for a return to work) until the following day; Friday March 15th.

It was then confirmed that my medical leave was extended until Friday March 15th, but that I had to submit a revised form by noon that day.

Last night I called this private clinic, to check the time for my appointment this evening. Rather that confirming my appointment, the receptionist advised me that it had been rescheduled – to next Thursday; 7 days later.

I was told that my appointment had been moved a month ago. When I asked why no one had contacted me, to advise me of this change, I was told that the appointment shouldn’t have been made on that date because the doctor had told them in February that he had to change his once-a-month clinic visit.

The receptionist seemed to be blaming me, insinuating that I must have written down the date incorrectly. As though it was my error. She didn’t seem to be listening as I explained that I already had my appointment before he’d have changed his February clinic date.

After a few minutes, their receptionist finally understood what I’d been telling her; that my March appointment had been booked back in January – and that my physician had been beside me as it was booked.

That if they’d had to reschedule an existing appointment after that, it would have been up to the clinic to advise me of the change. If for no other reason than to prevent me from showing up at the clinic for no reason tonight.

But, more importantly, I hadn’t been told that I was now going to miss a submission deadline for my STD insurance forms. Despite the fact that the clinic had known about the appointment change for a month.

At this point, I had to think past my anger and frustration – of how to approach the delay for the disability insurance form. It was past the close of business on the 14th, and a new STD form was due by noon the next day. The clinic had no suggestions on how to handle with issue.

I was on my own, left to deal with a problem that they’d created through a lack of basic client/patient service. If this clinic had advised me of the change in appointment date, I could have asked a member of my hospital team to fill in the form; I’d been at the hospital yesterday, for treatment, from 0915 to noon!

I called the (government-funded) family medicine clinic at which my physician also works, but they couldn’t fit me in until after the rescheduled appointment at the private centre.

Then I called the private clinic back, and asked them to send me an email stating a) my original appointment date/time, b) the new appointment date/time, c) that I hadn’t been advised of this change until that evening, and d) that there would be no physician on site the day of my original appointment (the next day).

They were, to their credit, quick to send me that email. I forwarded the private clinic’s email to my STD insurance contact, along with some additional information to explain the situation. Then I crossed my fingers and waited.

I didn’t sleep last night, worrying about whether this unplanned delay would have negative consequences on my payments – or on my employment status.

So much for this private centre’s promise to “focus on all aspects of your wellbeing, physical and mental”(1). They weren’t protecting my mental wellbeing, they were damaging it!

It’s bad enough that I have to deal with a debilitating illness, and constant pain. I now found myself having to deal with a stressful situation – caused by their lack of patient care. By a complete absence of respect, for a long-term patient.

Just before noon this morning, I received word that the one-week delay was authorized; I’d be paid next week, even though the STD insurance form would be late. I was lucky. If my insurer had refused to accept the last-minute delay, I’d have lost my income. Possibly my job.

That’s not acceptable. It wouldn’t be acceptable from a government-run healthcare centre, and definitely not from a private clinic to which I’ve already paid over $20,000.

All because they couldn’t be bothered to pick up the phone, or send an email, to let me know that my medical appointment had been rescheduled. Despite having had a month to do so.

And that’s today’s lesson in how not to manage patient care.

~~~~~~~~~~~~~~

(1) https://www.cappinophysio.ca

(2) https://cp64.clinicmaster.com/BookOnline/SelectDiscipline?disciplineCode=000001

(3) Yasmine Hoydonckx, Matteo Costanzi & Anuj Bhatia. A scoping review of novel spinal cord stimulation modes for complex regional pain syndrome. Canadian Journal of Pain. 2019. 3:1, 33-48, DOI: 10.1080/24740527.2019.1574536. Web: https://www.tandfonline.com/doi/full/10.1080/24740527.2019.1574536

 

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