This title’s a tribute to fans of crime or detective series* on television. In this type of show, the phrase 7 to 10 would refer to a prison sentence. In this post, though, I’m referring to a period of 7 to 10 days. When someone tells you that it will take 7 to 10 days to reply to your request, would you expect to hear back from them within about a week and a half?
Unfortunately, that’s usually not what’s meant. The concept of business days, rather than calendar days, seems to have become so ubiquitous – so widespread – that many healthcare companies and organizations don’t bother to specify it anymore. This, as you might imagine, can create confusion and disappointment for patients who’re thinking in terms of calendar days.
Once again I’ll use an event in my own patient journey, to illustrate this point. I’ve been on medical leave from work since the evening of December 20, due to an unexpected progression of my rare autoimmune and neuro-inflammatory disease. This included new symptoms which cropped up well over two years after my diagnosis, when I thought it couldn’t get any worse!
Here in Canada:
Short-term disability coverage typically provides benefits for up to 6 months while you’re sick or injured. If your employer has a short-term disability plan, your claim must be made through your disability plan. Employers aren’t required to provide paid sick leave and each employer is different.”(1)
So I consider myself to be very lucky that my job included short-term disability insurance, called STD, for a period of up to 26 weeks. That comes out to 6 months, so until June 20. [If you’re calculating the number of days, my first day away from work was December 21 because I’d worked a full day before I met with my family physician during the evening of December 20.]
Many large employers contract medical clinics to manage their STD program; mine did the same. This avoids requiring employees to submit their personal health information (PHI) – their confidential medical information – to their employer. That would create risks that an individual’s PHI could be accessed, and even shared, by their colleagues or supervisors.
My physician had to complete medical forms, just about every month, while I was on STD medical leave. The completed forms would be sent to the medical clinic administering the STD program, rather than to an insurer.
At the end of April, this medical clinic sent me a different set of forms; an application package for long-term disability (LTD) insurance. These multiple forms were to be completed only if my physicians didn’t expect that I’d be ready to return to work before June 20; the end of the STD period.
The clinic asked that the completed forms be returned to them by June 1. They would then transfer my file – and all these forms – to my employer’s group insurance company. This had to be done only if my physician didn’t expect me to be able to return to my job by mid-June.
I’ve written previously about receiving confirmation, from my family and hospital specialist physicians, that they felt I should remain off work past the six-month point. This was a traumatic decision for me, because I’d really hoped to return to my dream job soon. So I won’t cover that again here.
On May 24 I emailed the full set of completed LTD claim forms to the medical clinic. Some of the forms had to be completed by my physicians, so both my hospital specialist and my family doctor completed documents this time.
One of them had suggested that I include some information not requested in the LTD claim package; a list of all of the treatments that had been tried, to get my CRPS under control. So I added that to my claim forms.
The medical clinic sent me a confirmation, on May 29, that they had forwarded my application package to the insurance firm. Then I waited, very anxiously, for a reply from the insurance company. To be clear, as of June 20 I’m no longer receiving any income.
After 2 weeks, I hadn’t heard anything from the group insurance firm. I called them on Friday June 14. The person I spoke with advised me that my claim had just been assigned to a case manager that afternoon, and that I should expect a response within 7 to 10 days.
In calendar days, that would mean no later than June 24. That’s when many patients would have expected a reply – my father for instance. Although they hadn’t specified that this would be business days, I’d guessed that was what they meant. There’s a provincial holiday here in Québec on June 24, and then a national Canadian holiday on July 1, bringing those 10 business days to July 2.
There’s a difference, between calendar days and business days, of more than a week. It doesn’t seem like a particularly long time, but imagine that this was you; waiting to find out whether you’re going to receive any income, not only for the past 10 days but also for the future.
It’s an agonizing wait, on top of an excruciatingly painful disease. A stage in my patient journey that I’d truly have wished to avoid. And also annoying, because I’d submitted the forms almost a month before the end of my STD period…
If you work in healthcare, please keep this in mind. When you advise a patient (or caregiver) that they should hear back – for a test result, a follow-up, a response to a query, etc. – it would be helpful to specify whether you mean business days or calendar days.
Even better, show the patient on a calendar by which date they should expect a response. Let them know the specific date on which they should reach out to you if they haven’t heard back.
We’re all familiar with stories of Canadian patients not being contacted following positive test results, and then missing out on medically required follow-up testing or treatment. If it isn’t you they should contact, explain to the patient who they should call – and when.
This is a fairly simple request, with several benefits from my bioethics perspective;
- Involving patients in their own healthcare; in respect of their autonomy
- Preventing patients’ confusion and disappointment about response times; increasing beneficence
- Avoiding situations of patients being lost to follow-up, or failing to receive appropriate medical care; in support of non-maleficence and justice
My list of the potential benefits of my plea are loosely based on the 4 generally-accepted principles of biomedical ethics(2):
- Autonomy (respecting the decision-making capabilities of a competent patient, as an individual)
- Non-maleficence (avoiding that harm be caused to a patient, whether intentionally or not)
- Beneficence (providing benefit to a patient, which can require weighing risks of a treatment or healthcare decision against its benefits; the risk/benefit ratio)
- Justice (fairness as applied to patients; both as individuals and as members of groups)
As always, thanks for taking the time to read this post. Feel free to comment via Twitter or other social media; comments have been disabled on the blog, after multiple spam attacks from overseas.
* Some of my favourites have been
“Criminal Minds” (the early seasons), “CSI” (the original Las Vegas series), “Endeavour”,
“Flashpoint”, “Inspector Morse”, “Law & Order: Special Victims Unit”,
“Lewis”, “Maigret” “Millennium”, “Unforgotten”, and “Without a Trace”.
Some of these are esoteric series; for example “Maigret” stars Rowan Atkinson
(aka Mr. Bean) in an English adaptation of a series of French-language
detective novels. These were set in mid-1950s Paris, although their author was
the Belgian Georges Simenon. Mr. Simenon also lived in France, Canada, and the
United States. He lived near Montréal for some time, so there’s a lot of local
interest in his writing.
References:
(1) Government of Canada: Financial Consumer Agency of Canada. Disability
insurance. 13 Jun 2018. Online. Accessed 27 Jun 2019. Web:
https://www.canada.ca/en/financial-consumer-agency/services/insurance/disability.html
(2) Beauchamp TL. Methods and
principles in biomedical ethics. Journal
of Medical Ethics 2003;29:269-274. Online
(http://dx.doi.org/10.1136/jme.29.5.269). Accessed 27 Jun 2019. Web:
https://jme.bmj.com/content/29/5/269