Need to Report Urgent Care Doc, But Where to Exactly?

[Butter]

Last Sunday I woke up at 3:30 in the morning with horrible pain.  I knew right away it was gallbladder.  Or at least I was 99% sure.  I started having gallbladder attacks on occasion right after Adrian was born (almost 6 years ago), but I hadn't had one since last May so I had been doing really well.  The night before, though, my husband and I went to Olive Garden to celebrate my birthday and I had lots of cheese and creamy sauces and that triggered an attack.  Usually a couple lecithin pills, some Tylenol, and throwing up made me all better.  Not this time.

 

About 10:30 my husband took me to Urgent Care.  Turns out Urgent Cares in Texas can't do sonograms (at least according this this place).  So instead of saying go to the ER and get a sonogram, the doctor said it was typical gastroenteritis and the pain I was having between my shoulder blades and under my ribcage on the right side were from throwing up (he kept insisting the pain came *after* the throwing up even though I told him, as did my husband, several times that the pain came first).  He gave me a bag of fluid, which I did need since I had thrown up so much that morning.  I was happy with the gastroenteritis diagnosis because I did *not* want surgery (I actually never told a single doctor about the gallbladder attacks before Sunday because of that reason).

 

The doctor told me to go home and take Tylenol (I had twice already, but threw it up both times) and go on a BRAT diet and I'd be fine.  My husband asked if he was sure it wasn't gallbladder.  The doctor said there was almost no way it could be because the places I was complaining of pain were "definitely not" where you get pain from gallbladder problems.  My husband pressed it and the doctor said there was a "1 in 1000" chance it was gallbladder.  When the nurse said to take Tylenol as she was going over the discharge papers, I told her I had already done that and it didn't help and I threw it up.  Could I try Advil instead.  She looked at me and in this patronizing voice said, "How long have you had this muscular disorder?"  I told her since that morning.  I think she decided I was a drug-seeker.  I wasn't even asking about anything that wasn't over the counter!

 

Long story short, I went home, took the Tylenol, and threw it up so violently my throat began to bleed.  Jamie called the Urgent Care since they said to if anything changed and they said go to the ER.  Went to the ER.  Was *very quickly* diagnosed with an acute gallbladder attack.  The places I was having pain, they said, were "textbook classic gallbladder."  Confirmed it with a sonogram and by 6:30 that evening I was in the OR having surgery to remove my gallbladder because that stone stuck in the bile duct wasn't moving for anything.

 

Other than kind of being an arrogant jerk and misdiagnosing something the ER docs said was totally obvious, there were other red flags with the Urgent Care doctor.  He got creepy.  The ER nurse came in our room and said the UC doc had called to try to get information about my condition (which they could not share because of HIPAA of course).  The ER nurse was a little freaked out by that.  Apparently they had tried to call Jamie's phone, but cell service in ERs is spotty most of the time so it had gone to voicemail.  Since he didn't call them back right away they called the ER.  Jamie eventually called them back and told them I was having a gallbladder attack like we thought in the first place and were were waiting on the surgeon.  And then not long after we got home from the hospital Monday, they called Jamie's phone again to check on my condition.  Jamie was pretty stern telling them I was fine and made it clear further phone calls were not welcome.

 

Also, a child was in another room when I was there.  She was having an allergic reaction to an antibiotic her pediatrician had prescribed.  When she got to the UC her throat was quite swollen, but they were able to reverse that .  The doctor said she should get a steroid shot and 3 days of steroids.  This is reasonable.  However, her parents refused the steroids and signed they were refusing the doctor's recommendation and then left.  How do I know these details?  Because after they left the doctor and the two nurses stood in the hallway (there was only a curtain pulled between them and my room, no door) and *loudly* discussed the details of the case and were very rude about the child's parents and saying how refusing that meant the child would be in the ER in worse condition and it would be all their fault.  Because they were discussing the details with my husband and I right there and it was about someone we saw when we came in and when the family left, I am pretty sure that's a HIPAA violation, too.

 

And then, just annoying, in the middle of my time there the doctor went out and smoked a cigarette and then came in to examine me.  He reeked of cigarette smoke which is bad enough, but I was also severely nauseated (though he didn't believe me because they game me an anti-nausea drug - I'm pretty sure the nausea wasn't because of an unsettled stomach but rather due to the intense pain so it makes sense the drugs didn't work).  Having him bend over me and get in my face reeking of cigarettes made the nausea worse and me more miserable.

 

So, anyway, I feel like this doctor should be reported, particularly because of the HIPAA issues, but I'm not sure where to.  Does anyone know?  I'm in Texas if that makes any difference.  Thanks if you read all that!

[Heatherwith4]

Here's a place to report just HIPPA violations:

 

http://www.hhs.gov/ocr/privacy/hipaa/complaints/

[gardenmom5]

start with whomever runs the clinic - and the nurses should be reported also.  then copy a letter to your state medical board.

[Jean in Newcastle]

http://www.tmb.state.tx.us/page/place-a-complaint

[unsinkable]

For a misdiagnosis: Call the urgent care director. (You would have ended up in the ER anyway.)

 

IMO, there were no HIPAA violations. They were outside your room talking about the other patient. I thinks it is reasonable to assume that people in another room ( you and your DH) wouldn't be listening to them.

 

Calling your DH to follow up is not a HIPAA violation. Urgent Care has always followed up with us. If you called them with more emergent symptoms, and they told you to go to the ER, I think it's only decent for them to call.

[Butter]

The doctor IS the director.  They should have sent us immediately to the ER because they couldn't do sonograms there.  The ER doc was a bit befuddled at what the UC doc said since the symptoms were so obvious and textbook.  Plus we walked in saying we thought it was a gallbladder attack.

 

No, the ER people were very clear that it was a HIPAA violation, the UC calling the ER (obviously calling my husband is not).  They wanted details from the ER that were completely inappropriate to ask for particularly since I had signed nothing allowing them to talk to the UC.

 

In nursing school we were taught to NEVER speak about another patient in a hallway where other patients can hear what we were saying because that is a violation.  They were being LOUD.  There was no way to not hear what they were saying.

[unsinkable]

The doctor IS the director. They should have sent us immediately to the ER because they couldn't do sonograms there. The ER doc was a bit befuddled at what the UC doc said since the symptoms were so obvious and textbook. Plus we walked in saying we thought it was a gallbladder attack.

 

No, the ER people were very clear that it was a HIPAA violation, the UC calling the ER (obviously calling my husband is not). They wanted details from the ER that were completely inappropriate to ask for particularly since I had signed nothing allowing them to talk to the UC.

 

In nursing school we were taught to NEVER speak about another patient in a hallway where other patients can hear what we were saying because that is a violation. They were being LOUD. There was no way to not hear what they were saying.

I disagree but that's fine.

 

You need to do what you think is best.

 

Edited to add:

 

"Incidental Use and Disclosure -- The final Rule acknowledges that uses or disclosures that are incidental to an otherwise permitted use or disclosure may occur. Such incidental uses or disclosures are not considered a violation of the Rule provided that the covered entity has met the reasonable safeguards and minimum necessary requirements. For example, if these requirements are met, doctors' offices may use waiting room sign-in sheets, hospitals may keep patient charts at bedside, doctors can talk to patients in semi-private rooms, and doctors can confer at nurse's stations without fear of violating the rule if overheard by a passerby."

 

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalu&d.pdf

[cbollin]

Here's a link to a FAQ about incidential disclosures when things are overheard.  some things are permitted, but not all situations. and the burden is on the "covered entities" (doctors, health care personnel, etc) to establish the reasonable safeguards

 

http://www.hhs.gov/ocr/privacy/hipaa/faq/incidential_uses_and_disclosures/196.html

[unsinkable]

Here's a link to a FAQ about incidential disclosures when things are overheard. some things are permitted, but not all situations. and the burden is on the "covered entities" (doctors, health care personnel, etc) to establish the reasonable safeguards

 

http://www.hhs.gov/ocr/privacy/hipaa/faq/incidential_uses_and_disclosures/196.html

This is why I think it's not a violation. The doc and nurses were essentially in another room talking about a patient who was not known to Butter.

[kroe1]

My question would be why would you go to an urgent care for a gallbladder attack. You said you knew you had a problem for awhile. Why did you not see a surgeon or go straight to an ER? At any rate, did you get any paper work or follow up instructions from the walk in clinic?

 

At least where I live, ultrasounds are not even available in the ER after 10pm. Suspected gallbladder attacks get ultra sounded the next day followed by an outpatient surgery consult. The only time gallbladders are taken out emergently is for acute cholecystitis, an infected gallbladder. Perhaps expectations are different in Texas.

 

The smoke smell is disgusting, physician or not.

 

The hallway discussion is also tacky. Was the patient's name mentioned or any other identifying features? There are certain expectations of privacy, but in open rooms without private doors, those expectations are limited. While tacky and ethically disgusting, it may not be a HIPPA violation. The Texas Board of Medicine should be able to help.

 

Bottom line, are you feeling better now and did your surgery go well?

[cbollin]

This is why I think it's not a violation. The doc and nurses were essentially in another room talking about a patient who was not known to Butter.

 

I read it the opposite way and think a violation occured.  They were too loud in a situation that is not one of the exempt reasons.  It wasn't taking to the patient.

but I'm not a lawyer. 

[unsinkable]

I read it the opposite way and think a violation occured. They were too loud in a situation that is not one of the exempt reasons. It wasn't taking to the patient.

but I'm not a lawyer.

I play one on TV...plus I stayed at a Holiday Inn Express last night.

[Tammi K]

I say this gently because you obviously have had a difficult time and were in a great deal of pain. But, it sounds to me like you are looking for things to be angry about.

 

The initial doctor did not have the same diagnosis as the follow-up doctor. That doesn't mean he did anything wrong. That just means he had a different opinion. It happens.  Nurses were speaking in a hallway. It happens. The doctor smoked a cigarette. It happens. You were sick, in pain, and not happy with the way you were treated. That doesn't mean they did anything wrong.  At the very most, I think you might have witnessed a Hipa violation but that wasn't even the doctor who has you so angry.  It was the nurses.

 

Things sometimes don't work out in the best way but that doesn't mean you'll get any results from reporting it. Really, what do you have to gain. I think your energy would best be spent by putting it behind you and focusing on your recovery. Hugs to you! I do understand - my gallbladder surgery was a travesty of screw-ups that would turn you grey.  In the end, I think your energy is better spent on healing. :grouphug:

[Jean in Newcastle]

My 2 cents:  You don't go to Urgent Care for gallbladder attacks.  Urgent care isn't really equipped to handle things of that sort.  So, I wouldn't expect an urgent care doctor to recognize that or know how to treat it.  (This may not be the way it "should" be, but my experience with urgent care docs are that they aren't the most experienced docs out there.)  If they had diagnosed gallbladder initially, wouldn't they have just told you to go to the ER?

 

Is calling to find out someone's status creepy?  It could have been concern since they had told you to go to the ER or it could have been fear that they had misdiagnosed things initially but since they told you to go to the ER in the end, they did tell you ultimately to do the right thing.  (I have no idea why your dh told them you were fine since  you had to have surgery unless he was telling them that surgery went well.)  Asking you how you are doing isn't a violation of HIPPA.  Asking the ER for your condition was out of line but since the ER said no, they upheld HIPPA.

 

People smoke.  Not a good habit but I'm not sure it is reportable.  

 

The situation with the other patient.  Unless they said her name or other identifying details, I'm not sure that is a violation.  

 

 

[Unicorn.]

Butter, glad you are okay!   Just curious, was it an Urgent Care, or a Tx Med Clinic?  I ask because our Urgent Care is fabulous, but the TX Med Cllinics are a joke.  I think the docs who work there got their degrees from a gumball machine.

 

I understand why they called your dh, but calling the ER.. that's creepy and out of line.  He was probably panicking for misdiagnosing you. 

[trulycrabby]

I think he called because it was a misdiagnosis, he knew it, and was concerned about it.

 

I have to read about the possible HIPPA violation again, but if you have been to nursing school, you probably judged correctly.

 

I hope you heal quickly and feel much better very soon! :)

[Saraswati]

Jamie eventually called them back and told them I was having a gallbladder attack like we thought in the first place and were were waiting on the surgeon.

Unfortunately, you gave the doctor your DX. I'd be willing to bet he's already updated your file to state that he advised you to seek medical attention at the ER to R/O the DX you provided him. Reporting him will likely go nowhere. As far as the hallway discussion, it's definitely unprofessional; however, without names mentioned, in an ER or UC setting, it will also likely go no further than a "hand slap" for the staff involved - if they even get that. Sadly, medical professionals have the right to smoke cigarettes while on duty. Unless you can prove that he did so, and did not wash his hands prior to examining you, that will also go nowhere.

 

I'm sorry for your bad experience, and I'm glad you found proper care. I completely understand the want to seek reprimand for the staff that mistreated you. Some people just don't have bedside manor to work in healthcare. 😒

[Catherine]

This is a great place to talk a bit about EDs, urgent care, and what they are actually, IMO, best used for. My disclaimer is that I am a doctor and spend a fair amount of time in the ED, though I am not an emergency medicine person, I'm an internist.

 

UC is really meant for problems you'd see your PCP for, but cannot get a very quick appointment, for minor injuries, and problems that will not require a surgeon. So lacerations that need stitching, broken bones that are not obviously displaced, illnesses like earaches, gastroenteritis, sprains.

 

I have seen countless cases of heart attacks, life-threatening allergic reactions, ICU-level infections that come in to the ED after first visiting UC. Truly, a life is at stake here. You should think very carefully before choosing UC if you:

 

1) have no idea what is wrong with you

2) have a symptom that could potentially require surgery or threaten your life

 

Because you first of all have introduced a delay into your care for a problem in which time may really be of the essence, and second of all, you have complicated your own situation by seeking help from people who cannot help you.

 

Medicine is a messy business. We Americans are very accustomed to being treated like customers and that model most definitely does not apply to situations where you are really sick. I'm not defending the UC doctor's stupidity and bad manners in discussing someone else's case within earshot, but I agree with others who've pointed out that it probably does not rise to the level of a HIPAA violation. And his failure to listen to you and make the correct diagnosis shows he's incompetent, but not necessarily negligent.

[Rebel Yell]

To the OP:  I hope you're feeling better soon. :grouphug:

 

For those who wonder why anyone would go the an urgent care place with a gall bladder attack, heart attck, severe infection etc:  I can think of several reasons. 

1. We are not doctors- so maybe we don't KNOW what's wrong with us- that's why we go to the urgent care.

2. We hear/read all kinds of stories about people "wasting" the ER/Emergency Dept time on trivial things like bronchitis and ear infections and we don;t want to be that "idiot" who went to the ER when we should have just had some hot tea and a good night's rest.

3. Our health insurance will not pay for an ER visit if we're not admitted, so we try other places first.

4. We're in denial about how sick we really are, or are the kind of people who just really hate or fear hospitals, so Urgent Care will get us in the door when we'd nearly die avoiding the hospital.

[Halftime Hope]

. And his failure to listen to you and make the correct diagnosis shows he's incompetent, but not necessarily negligent.

 

Catherine, could you state in plain English, so I can understand, what the difference is between incompetent and negligent? 

 

If a doctor who is supposed to provide a certain level of medical services (in this case proper triage and referral to care) is so incompetent that they can't recognize a fairly well-known disease and send the patient to get good care, isn't that negligence?

 

Truly seeking to understand.  Thanks.

[plansrme]

The problems you are describing mean the doctor is a bad employee, not necessarily that he is a bad doctor.  Maybe he is a bad doctor as well--I don't know, but I would report the behavior to his employer, including that he reeked of smoke.  It would be interesting to know what your chart says now, i.e., whether the doctor really did change it after the fact.  If it is an electronic chart, rather than a paper chart, I wouldn't think that would be possible, but maybe.  If/when you write, be non-emotional, with fewer details than are in your post.  A simple, "I complained of X, Y and Z," and Dr. Shmo insisted it couldn't be my gallblader when the ER said, instead, that I had classic symptoms," etc.  

 

As for HIPAA, unless there was a name or other identifyiing information (an address, for example) included, there was not a HIPAA breach.  It is fine to gossip about your patients as long as you do not identify them (or give away enough information for someone else to identify them).

[Aelwydd]

The overheard conversation by the nurses was one of the scenarios covered in clinicals when HIPPA was discussed. I think there is some evidence for a violation,  in that they did not only discuss objective facts about the girl's case. They also shared irrelevant, subjective opinions about the case as well, and in doing so, appear to have revealed even more personal information about the family.

Futhermore, loudly discussing another patient's case next to another patient, with only a curtain between, and no compelling reason to do so (i.e., the patient being discussed is actually present), then, yeah, that's bad. At the very least, it casts a negative light on the staffing's training and level of credibility. Especially as only one nurse was likely involved in the case, and the other probably didn't require the information or the rude opinions about it from the first nurse.

Highly unprofessional and I'd report it, along with the misdiagnosis, and the exposure to second hand smoke on the physician's clothing.

That said, I'm also surprised you didn't go straight to an ER to begin with. If you knew it was gallbladder, then whether or not an UC has a sonogram, you'd still require the services of a surgeon. When my best friend was experiencing similar symptoms, it was straight to the hospital. What could an UC even do, besides charge an exta fee for possibly correctly diagnosing an acute condition they can't even treat?

[Aelwydd]

Catherine, could you state in plain English, so I can understand, what the difference is between incompetent and negligent?

 

If a doctor who is supposed to provide a certain level of medical services (in this case proper triage and referral to care) is so incompetent that they can't recognize a fairly well-known disease and send the patient to get good care, isn't that negligence?

 

Truly seeking to understand. Thanks.

Malpractice (Incompetence)- physician does not recognize or correctly treat a condition, according to medical standards of practice, resulting in gross errors or mistakes

 

Negligence- physician fails to do something he should have done, ex., failure to warn a patient about risks, or fails to refer a patient to a specialist

[Aelwydd]

To the OP: I hope you're feeling better soon. :grouphug:

 

For those who wonder why anyone would go the an urgent care place with a gall bladder attack, heart attck, severe infection etc: I can think of several reasons.

1. We are not doctors- so maybe we don't KNOW what's wrong with us- that's why we go to the urgent care.

2. We hear/read all kinds of stories about people "wasting" the ER/Emergency Dept time on trivial things like bronchitis and ear infections and we don;t want to be that "idiot" who went to the ER when we should have just had some hot tea and a good night's rest.

3. Our health insurance will not pay for an ER visit if we're not admitted, so we try other places first.

4. We're in denial about how sick we really are, or are the kind of people who just really hate or fear hospitals, so Urgent Care will get us in the door when we'd nearly die avoiding the hospital.

 

All true, but the OP suspected gallbladder from the outset, due to previous history. It's one thing if you think it's probably just heartburn; it's another when you are having severe symptoms and a high likehood of a serious condition.

 

My confusion is really about OP's focus on the lack of sonogram at the UC. Even if they did have one, a sonogram is not always a definitive thing. One can have a clear sonogram, because small stones are difficult to detect, and still have a problem. That would make a referral to a hospital or specialist necessary anyway.

 

And if the sonogram did detect something, and the doctor recognized it, it's off to the ER.

 

All roads lead to the ER in a case like this with severe symptoms. The UC only ends up adding more to the final bill.

[Only me]

I also think urgent care facilities vary from state to state. Where I live they are for anything from sore throats to more serious problems. They have diagnostic tools like sonagrams, X-rays, administer IVs etc. if you are diagnosed with something requiring hospitalization or surgery then they send you to the hospital. They really are set up for emergencies but usually without the wait of an ER.

 

On the other hand we found out that urgent care in Orlando is completely different. My 21 year dd is in Orlando on an internship and needed care. She was having a bad reaction to a medication. She called around to a few places before she went and was told they only handle "boo boos" their exact words. They don't give IVs or handle anything remotely serious. They basically just handle things a primary care doctor would. She had to go to the ER instead. Had she been home our urgent care would have been able to take care of her without the long wait.

[PrincessMommy]

This is why I think it's not a violation. The doc and nurses were essentially in another room talking about a patient who was not known to Butter.

 

That's odd, because I was clearly told in my hospice training that discussing a patient in an area, *such as a hallway* was a violation because the conversation could be overheard.   It's probably best if she report it and let them decide if it warrants further action.

 

And, OP - I completely get going to Urgent Care first too.   I ended up in the ER last night with an asthmatic child.  Getting her treatment took 4hrs whereas, if the UC facility would have been open, we could have been done in less than 2.  I called our PCP and he said go to UC, but sadly they were closed.   We went to a satellite emergency room, which was nearly empty...but my dd came out of the ER hating hospitals and their waste.  I can't imagine how much worse it could have been at the big, busier hospital ER. She's had two negative experiences at the ER treating an asthma attack.  It's going to be very hard to convince her she needs to go, if there's a next time.

[Aelwydd]

That's odd, because I was clearly told in my hospice training that discussing a patient in an area, *such as a hallway* was a violation because the conversation could be overheard.   It's probably best if she report it and let them decide if it warrants further action.

 

And, OP - I completely get going to Urgent Care first too.   I ended up in the ER last night with an asthmatic child.  Getting her treatment took 4hrs whereas, if the UC facility would have been open, we could have been done in less than 2.  I called our PCP and he said go to UC, but sadly they were closed.   We went to a satellite emergency room, which was nearly empty...but my dd came out of the ER hating hospitals and their waste.  I can't imagine how much worse it could have been at the big, busier hospital ER. She's had two negative experiences at the ER treating an asthma attack.  It's going to be very hard to convince her she needs to go, if there's a next time.

 

Same here, have an asthmatic child.  My experiences with both ERs and UCs have been mixed.  I have dealt with moronic staff in both cases.  Asthma is on a continuum though.  Many times, a flare up can be handled in a UC, because while there is a crisis, it can be dealt with via steroids and vasodilators like albuterol treatments.

 

However, asthmatics generally do have certain signs and/or tools they can use to discern when an event is truly escalating to life threatening.  For one thing, we have a spirometer.  We also have a nebulizer.  And one can purchase a pulse oximeter as well.  If the spirometer and pulseOX show very low readings, and if you are seeing cyanotic (blueish tinged lips and greyish pale skin), you can determine pretty quickly if the child is suffering from very low oxygenation levels. 

 

 

Of course, there is personal judgment that has to be made. But, compromised airways, infection, severe bleeding, severe pain, etc., I would tend to think "emergency" rather than just "urgent," you know?  Strep throat is "urgent"; severe pain that induces vomiting, and is radiating from the abdomen-- that's emergency!

[Butter]

This is why I think it's not a violation. The doc and nurses were essentially in another room talking about a patient who was not known to Butter.

 

Actually, they were directly outside the curtain covering the doorway to my room (which only partially covered the doorway).  They were not near a nurse's station or anything like that.  They were so close to my room one of them was actually touching the curtain.  And they were being very, very loud.  It would be different if they were talking in low voices directly outside my room.  They do not know that the other patient was unknown to me.  I saw the family before they went in and as they were leaving.

 

Having talked to other people who have gone to that UC, apparently my experience was not unusual.

[Butter]

My question would be why would you go to an urgent care for a gallbladder attack. You said you knew you had a problem for awhile. Why did you not see a surgeon or go straight to an ER? At any rate, did you get any paper work or follow up instructions from the walk in clinic?

 

Mainly because I was not aware you could not get a sonogram from them.  I just moved to TX last year from MD.  In MD Urgent Cares have ultrasound machines.  It didn't even occur to me that TX UC's don't.  I did not go to a surgeon (or any doctor) because I didn't want surgery.  Had I known beforehand, or had they told me when I got there, that they couldn't do a sonogram, I'd've gone to the ER in the first place.  It never occurred to me that I could have surgery the same day.  Even after I went to the ER I figured they'd send me to a doctor to schedule it for later.  (ETA: Plus I didn't see it as an emergency.  I only go to the ER if there is no other choice.  And on top of that, the ER co-pay is $175 - though that was waived since I was admitted from the ER - and the Urgent Care co-pay is $40.  Prior to them telling me they can't do sonograms at Urgent Cares in TX I figured they'd do an u/s, confirm it was a gallbladder attack, give me something to make me feel better, and tell me to call a surgeon on Monday - since this was on Sunday.  That's how it would've gone in Maryland.)  The follow-up instructions from the UC was to go on the BRAT diet and wait out the "gastroenteritis" that I most definitely had (according to the doctor).  And take Tylenol for my "muscular disorder."  Oh, and come back (to the Urgent Care) if I got worse.

 

The surgeon at the ER decided it was an emergency situation and did the surgery on a Sunday.  I was actually shocked when he said "We can do the surgery right now" and literally meant I'd be in the OR within an hour.

 

The surgery did go well and I am healing.  Still very sore and get tired easily, but every day is better.

[Butter]

At the very most, I think you might have witnessed a Hipa violation but that wasn't even the doctor who has you so angry.  It was the nurses.

 

Um... no.  It was the *doctor*.  He was speaking to the nurses.  HE was the one being loud and giving details (and disparaging the child's parents and their decisions).  I am very clear on this because the nurses did not have any accent and he did have a mild one.  It was very obvious who was speaking when since one nurse was a male and one was a female.  So it was the doctor giving the details of the child's case, not the nurses.  They were just kind of agreeing with the doctor.

 

And I'm actually not angry.  I just think the doctor did things wrong (and the ER people were in agreement with me when I told them about it and they urged me to "do something about it").

[Butter]

Butter, glad you are okay!   Just curious, was it an Urgent Care, or a Tx Med Clinic?  I ask because our Urgent Care is fabulous, but the TX Med Cllinics are a joke.  I think the docs who work there got their degrees from a gumball machine.

 

I understand why they called your dh, but calling the ER.. that's creepy and out of line.  He was probably panicking for misdiagnosing you. 

 

I have no idea,  They're sign says they are an Urgent Care.  ___ TX Urgent Care.  The doctor told us he is a former ER doctor and that's why he knew it was not gallbladder.  1 in 1000 chance it was gallbladder.

 

I don't have a problem with them following up with my husband.  That's pretty normal (and my husband said I was fine because the surgery went well).  Calling the ER was weird and the ER nurse was pretty creeped out by it.  I suspect you are right that he was panicking over the misdiagnosis, especially since we asked specifically about gallbladder.

 

I definitely don't think he was negligent in any way, nor would I ever sue him or anything (though I wonder if the actions of continually calling my husband's cell phone - which kept going to voicemail - and calling the ER might because he thought I might).  I just think he's incompetent.  Some doctors are.  I later found out that one of my friends had a similar experience with the same UC/doctor about getting stitches for her son.  Only after the doctor examined him (they had been sent there by their pediatrician for stitches) did the doctor say he can't do stitches and to go to the ER for them.  (She's been in TX two years and both states she previously lived in could do stitches in an UC so it didn't occur to her this one couldn't.)  And then he billed them and their insurance for the visit.  They didn't pay.  I actually don't even plan on fighting the cost of the visit because he *did* give me fluids and anti-nausea medicine which I needed.

 

(and sorry about the serial posting.  I can't figure out multiquote to get it to work right for me.)

[Butter]

The problems you are describing mean the doctor is a bad employee, not necessarily that he is a bad doctor.  Maybe he is a bad doctor as well--I don't know, but I would report the behavior to his employer, including that he reeked of smoke.  It would be interesting to know what your chart says now, i.e., whether the doctor really did change it after the fact.  If it is an electronic chart, rather than a paper chart, I wouldn't think that would be possible, but maybe.  If/when you write, be non-emotional, with fewer details than are in your post.  A simple, "I complained of X, Y and Z," and Dr. Shmo insisted it couldn't be my gallblader when the ER said, instead, that I had classic symptoms," etc.  

 

As for HIPAA, unless there was a name or other identifyiing information (an address, for example) included, there was not a HIPAA breach.  It is fine to gossip about your patients as long as you do not identify them (or give away enough information for someone else to identify them).

 

He owns the place.  He's his own employer.  I think now we know why the other Urgent Cares in the area are busy while that one is almost always empty.

 

I know for a fact he smoked a cigarette while I was there since he did not reek the first time he came in, but did the second time.

 

If they did change the chart, I have the paperwork saying that I had gastroenteritis.  No mention of gallbladder on the paperwork they gave me.

 

There was definitely enough information in what they said to identify her if I tried hard enough.  He stated her age, grade in school, that her mom was at home with her younger sibling.  The name of her doctor.  The antibiotic the ped gave her that she reacted to.  A few other things that seemed odd to even say (this was in the course of disparaging the parents and saying how they were putting their kid at risk by not doing the steroids - which I do agree with - but it got rather personal and rude about them).  Plus I physically saw the child and dad.  I don't know them, but there was enough I probably could find out who they were if I tried.  Particularly since I now know who the ped is and I know people who see the same doctor.  In nursing school we were taught never to ever speak any details about a person's case if there was a chance someone who was not hidden and eavesdropping (such as if we were sitting in the nurse's station and someone was just out of view) could overhear and identify the person.  Even at the nurse's station we were to be very quiet about it.

[Butter]

I also think urgent care facilities vary from state to state. Where I live they are for anything from sore throats to more serious problems. They have diagnostic tools like sonagrams, X-rays, administer IVs etc. if you are diagnosed with something requiring hospitalization or surgery then they send you to the hospital. They really are set up for emergencies but usually without the wait of an ER.

 

That's what I am used to in Maryland.  An Urgent Care that does pretty much everything an ER does except admit you to the hospital.  And then, if there is something that will require hospitalization, they admit you directly to the hospital rather than sending you to the ER.  I have been waiting at an UC and a guy came in all bloody from a lawnmower accident and they called a nurse practitioner out immediately and had the nurse look and see if it was something they could stitch up (it wasn't, he was sent directly to the ER; they did not see him beyond sitting in the waiting room).

 

What I figured would happen is they'd do a sonogram, diagnose gallbladder, give me something to feel better for the time being, and send me home with instructions to call a surgeon the next day.  It was a Sunday.  I didn't think they'd even consider doing surgery on a Sunday.  Because of my experience with Urgent Cares in MD, I figured the UC could do all of that and for a much cheaper price than the ER.  I once (in MD) went to the ER with severe vomiting and diarrhea (that time it was gastroenteritis lol) and they chastised me for taking up valuable ER resources (they were very busy... mostly with people with severe vomiting and diarrhea) and told me next time go to the Urgent Care because if it isn't going to require an immediate admit to the hospital (or stabilization and move to another hospital) and UC is open, go there, not an ER.  Apparently TX is different.  But since I never thought I'd be heading to surgery that very night and spending the night in the hospital UC made more sense to me (at least if the UCs here were like the UCs in MD).  I've definitely learned a lesson that not all Urgent Cares are created equal (or that the laws governing UCs are equal among the states).

[magnificent_baby]

Don't mean to be harsh, but I don't think you should be upset that he misdiagnosed you when you weren't fully truthful about how long your symptoms have been going on. Abdominal pain is difficult to diagnose, especially without diagnostic equipment. You could have left the UC and gone to the ER when you realized they did not have an US machine, or asked at check in. 

 

It is not uncommon at all for a provider to call an ER to check on their patients, especially when you called him reporting bleeding from your throat. It's also surprising that the ER nurse thought it was 'creepy' for him to call. IMO, he was concerned about you and what happened that worsened your condition. 

 

Yes, he sounds unprofessional, but I don't think it's a violation for you to overhear discussions in the hallway. Perhaps they were trying to convince the parents to adhere to the treatment as they were walking out. He didn't come into your room to discuss the other patient. 

 

I'm glad you are okay, and got the gallbladder taken out. A bad gallbladder can cause very serious complications such as pancreatitis. Perhaps if you told him that this had been going on for 6 years, he would have handled it differently.  

[Butter]

Don't mean to be harsh, but I don't think you should be upset that he misdiagnosed you when you weren't fully truthful about how long your symptoms have been going on. Abdominal pain is difficult to diagnose, especially without diagnostic equipment. You could have left the UC and gone to the ER when you realized they did not have an US machine, or asked at check in. 

 

It is not uncommon at all for a provider to call an ER to check on their patients, especially when you called him reporting bleeding from your throat. It's also surprising that the ER nurse thought it was 'creepy' for him to call. IMO, he was concerned about you and what happened that worsened your condition. 

 

Yes, he sounds unprofessional, but I don't think it's a violation for you to overhear discussions in the hallway. Perhaps they were trying to convince the parents to adhere to the treatment as they were walking out. He didn't come into your room to discuss the other patient. 

 

I'm glad you are okay, and got the gallbladder taken out. A bad gallbladder can cause very serious complications such as pancreatitis. Perhaps if you told him that this had been going on for 6 years, he would have handled it differently.  

 

???  I *DID* tell him it was going on for almost 6 years.  I'm not sure where you got the idea I didn't.  I told him I started having these attacks right after my youngest was born and the last had been in May.  I told him usually the attacks didn't last more than 2 hours and I was able to stop them myself.  *This* time it had started at 3:30 that morning.  I had never gone to a doctor about it before, so prior to Sunday I never told a doctor (which is what I said in my OP).  However, I gave the whole story to the doctors on Sunday.  It would be silly to not give the whole story once I sought treatment.

 

My husband did not report to him that I was bleeding when I threw up.  He just told him that I took the Tylenol like he said to and I had thrown it up.  I actually had not told my husband I had bled, just that I threw up, before he called the UC.

 

The family had left before they talked about them.  I know this because I saw them leave the building.

[Catherine]

Catherine, could you state in plain English, so I can understand, what the difference is between incompetent and negligent? 

 

If a doctor who is supposed to provide a certain level of medical services (in this case proper triage and referral to care) is so incompetent that they can't recognize a fairly well-known disease and send the patient to get good care, isn't that negligence?

 

Truly seeking to understand.  Thanks.

Now that I've said it, I have to think a little bit about my answer. I think incompetence means-not always careful in history taking and examination, (as this doc obviously was), versus negligence-failure to look at a test that was done, which result would have changed the outcome. IE, did not look at the EKG before discharging a patient with chest pain.

 

I wish every physician was careful and detail oriented at all times, but that is not the case. It's one reason why you get this annoying phenomenon of having to tell your story to multiple different people when you are feeling horrible. It's a way of preventing one person's missing an important detail from becoming a determining factor in the outcome. I think it's also the reason that hospitalists do not have worse outcomes than having your own internist care for you when you're in the hospital-all the changes of care and providers actually allow for more than one person to think about your case. That is probably a good thing.

[magnificent_baby]

???  I *DID* tell him it was going on for almost 6 years.  I'm not sure where you got the idea I didn't.  I told him I started having these attacks right after my youngest was born and the last had been in May.  I told him usually the attacks didn't last more than 2 hours and I was able to stop them myself.  *This* time it had started at 3:30 that morning.  I had never gone to a doctor about it before, so prior to Sunday I never told a doctor (which is what I said in my OP).  However, I gave the whole story to the doctors on Sunday.  It would be silly to not give the whole story once I sought treatment.

 

My husband did not report to him that I was bleeding when I threw up.  He just told him that I took the Tylenol like he said to and I had thrown it up.  I actually had not told my husband I had bled, just that I threw up, before he called the UC.

 

The family had left before they talked about them.  I know this because I saw them leave the building.

 

Sorry, I must have misunderstood. I think when you said you were happy with the gastroenteritis diagnosis, I assumed you weren't aggressively trying get him to consider any other diagnosis, other than your husband pressing him. Sorry you had a bad experience. You could have refused treatment and gone immediately to the ER, if you weren't happy with his diagnosis. 

[Anne in CA]

I am stunned at how many people (people who would probably never return to a restaurant after a bad meal) think this is not a big deal. I am really glad OP is reporting this, for the simple reason that as much as medical care costs it should be much better than it is. It is a big deal to give all the relevant information to a physician and get such a wrong diagnosis, and believe me, he is billing hundreds if not more than a thousand dollars for this "service", and it is not okay for a physician to examine someone reeking of cigarette smoke, and it is not okay for you to have to listen to someone else's problems on the other side of a curtain.

 

If I treated people that way in my restaurant I would be flat broke, but I am floored that it is fine for a physician to behave this way in some people's eyes. If this were an eating establishment where you were served by a dirty server (and the doctor was dirty after his cigarette make no mistake), got food you didn't order, and were billed an exorbitant amount of money for food you couldn't eat you would make a online review to say the least, but somehow the doctor is exempt from such honest treatment? 

[unsinkable]

I am stunned at how many people (people who would probably never return to a restaurant after a bad meal) think this is not a big deal. I am really glad OP is reporting this, for the simple reason that as much as medical care costs it should be much better than it is. It is a big deal to give all the relevant information to a physician and get such a wrong diagnosis, and believe me, he is billing hundreds if not more than a thousand dollars for this "service", and it is not okay for a physician to examine someone reeking of cigarette smoke, and it is not okay for you to have to listen to someone else's problems on the other side of a curtain.

 

If I treated people that way in my restaurant I would be flat broke, but I am floored that it is fine for a physician to behave this way in some people's eyes. If this were an eating establishment where you were served by a dirty server (and the doctor was dirty after his cigarette make no mistake), got food you didn't order, and were billed an exorbitant amount of money for food you couldn't eat you would make a online review to say the least, but somehow the doctor is exempt from such honest treatment?

 

The doctor made a misdiagnosis. It happens. Butter/Heather WAS treated...fluids and meds and was self reported "happy with the diagnosis."

 

Her symptoms became more emergent and she was advised to go to the ER.

 

I am more surprised that people would think a doctor would falsify a record to change the diagnosis after the fact. That doesn't even make sense. He didn't send her home with no care and then she died.

 

 

[vonfirmath]

5-ish years ago I went to a Urgent Care (in Texas) with a suspected gallbladder attack.  It was at the end of the day so I couldn't get into the doctor.  I got prescribed percocet and to see my normal doctor in the next 2 or 3 days even if symptoms improved.  With the regular doctor we planned an orderly gallbladder removal surgery -- they prefer to do this when NOt in the middle of an attack if possible. And that's what happened.

 

So just a note that SOME Urgent cares can handle gallbladder attacks better than yours did!

[magnificent_baby]

I am stunned at how many people (people who would probably never return to a restaurant after a bad meal) think this is not a big deal. I am really glad OP is reporting this, for the simple reason that as much as medical care costs it should be much better than it is. It is a big deal to give all the relevant information to a physician and get such a wrong diagnosis, and believe me, he is billing hundreds if not more than a thousand dollars for this "service", and it is not okay for a physician to examine someone reeking of cigarette smoke, and it is not okay for you to have to listen to someone else's problems on the other side of a curtain.

 

If I treated people that way in my restaurant I would be flat broke, but I am floored that it is fine for a physician to behave this way in some people's eyes. If this were an eating establishment where you were served by a dirty server (and the doctor was dirty after his cigarette make no mistake), got food you didn't order, and were billed an exorbitant amount of money for food you couldn't eat you would make a online review to say the least, but somehow the doctor is exempt from such honest treatment? 

 

To me, it seems like she went in: 1) fairly certain what it was 2) happy with the (wrong) diagnosis 3) consented to his treatment instead of leaving, if she felt he was wrong 4) didn't ask for meds stronger than over the counter, which I think is what she wanted to help her get through until Monday 5) now upset about a misdiagnosis that she wanted to wait until Monday for anyway?

 

I do agree he was unprofessional with smoking before examining her, that is unacceptable. 

[Butter]

The doctor made a misdiagnosis. It happens. Butter/Heather WAS treated...fluids and meds and was self reported "happy with the diagnosis."

 

Her symptoms became more emergent and she was advised to go to the ER.

 

I am more surprised that people would think a doctor would falsify a record to change the diagnosis after the fact. That doesn't even make sense. He didn't send her home with no care and then she died.

 

Sort of.  My symptoms stayed the same including throwing up the Tylenol.  I told him I had taken Tylenol twice that morning before going in to see him and had thrown them up both times.  I took it the third time on his orders and threw up again.  Just like I had before.

 

I did not tell the doctor I was happy with the diagnosis.  I was miserable in general.  By happy with the diagnosis I mean I was willing to believe that it wasn't gallbladder because I knew if it was I'd eventually have to have surgery.  i.e. it made me happy that he was telling me it wasn't something that would lead to surgery.  I did tell him I didn't think he was right because I had had the same symptoms before and they went away within 2 hours upon treatment with home remedies.  He told me that was unrelated.  My husband was very unhappy with the diagnosis and made that clear.  We left with him telling the doctor he thought he was wrong and the doctor saying he was a former ER doctor and so he was definitely right.

 

I doubt he'd falsify a record.  I do wonder if he wrote in there at all that we suspected gallbladder.  That would be interesting to know since we told the receptionist when we got there, the nurse when he took my vitals and history, and the doctor when he came in (which makes me wonder why they didn't tell me they couldn't do a sonogram to diagnose gallstones until after I was hooked to the IV).  But I truly don't think he'd go back and change the record after the fact.

[unsinkable]

Sort of.  My symptoms stayed the same including throwing up the Tylenol.  I told him I had taken Tylenol twice that morning before going in to see him and had thrown them up both times.  I took it the third time on his orders and threw up again.  Just like I had before.

 

I did not tell the doctor I was happy with the diagnosis.  I was miserable in general.  By happy with the diagnosis I mean I was willing to believe that it wasn't gallbladder because I knew if it was I'd eventually have to have surgery.  i.e. it made me happy that he was telling me it wasn't something that would lead to surgery.  I did tell him I didn't think he was right because I had had the same symptoms before and they went away within 2 hours upon treatment with home remedies.  He told me that was unrelated.  My husband was very unhappy with the diagnosis and made that clear.  We left with him telling the doctor he thought he was wrong and the doctor saying he was a former ER doctor and so he was definitely right.

 

I doubt he'd falsify a record.  I do wonder if he wrote in there at all that we suspected gallbladder.  That would be interesting to know since we told the receptionist when we got there, the nurse when he took my vitals and history, and the doctor when he came in (which makes me wonder why they didn't tell me they couldn't do a sonogram to diagnose gallstones until after I was hooked to the IV).  But I truly don't think he'd go back and change the record after the fact.

 

Butter Heather (that is your new name! :lol: )

 

I'm glad you're OK.  You need to do what you think is correct in regard to the care you received.  

 

I hope you continue to heal quickly!

[Butter]

To me, it seems like she went in: 1) fairly certain what it was 2) happy with the (wrong) diagnosis 3) consented to his treatment instead of leaving, if she felt he was wrong 4) didn't ask for meds stronger than over the counter, which I think is what she wanted to help her get through until Monday 5) now upset about a misdiagnosis that she wanted to wait until Monday for anyway?

 

I do agree he was unprofessional with smoking before examining her, that is unacceptable. 

 

You seem to read a lot into me saying I was happy with the diagnosis of gastroenteritis.  To me, gastroenteritis meant no surgery and someone could have told me I was about to give birth (vaginally) to unplanned triplets at that point and I'd have been happy. Because it meant no surgery.  I was terrified of having surgery.  At no time did I tell the doctor I *agreed* with his diagnosis (because I really didn't and he kept telling me I had symptoms that I did not have - and I told him I did not have - but would have indicated gastroenteritis) and my husband was questioning his diagnosis strongly.  Of course I consented to his treatment!  I was hooked up to an IV before he even said what I had or that he could not do a sonogram.  He initially came in, said I was dehydrated (I was from all the vomiting) and they hooked me up.  That was before he came in to do the actual exam (after smoking his cigarette).  As soon as I asked if I could take Advil instead of Tylenol since I'd already thrown up Tylenol, the nurse became really patronizing about my "muscular disorder" (which the doctor insisted was caused by a pulled muscle from throwing up... except I told him and my husband told him several times that the pain came first).  I didn't even think about stronger stuff because the only time in my life I'd ever had anything stronger than OTC was one Tylenol 3 after the birth of my daughter.  I'm not upset about his misdiagnosis.  I just thought he was an idiot and talking to other people (who he has also completely misdiagnosed, even for simple things) has made me realize he totally is and maybe should not be practicing medicine or at least people need to know he is pretty incompetent and avoid his place.

[Butter]

I figure I will report it (many people IRL at the ER and also who have gone to that UC and seen that doctor and had bad experiences with him have encouraged me to).  Thank you to those who provided links on where to report.  The powers that be can decide whether they should take any action.  I know this doctor has had at least two complaints lodged against him by people I know (of course this is something you don't find out until after they hear what happened to you and then they tell you their experience!).  I'll probably send a copy to the insurance company, too, since he's a preferred provider with them and maybe put a review on-line.  The really weird thing is according to their website they DO do sonograms and x-rays, but they told me while I was there that they don't (it also says they do stitches but they told my friend they didn't do those either).  That's kind of strange.

 

ETA: I just looked at some reviews.  He gets BAD reviews.  Lots of them.  And most are very similar to my complaints.  Note to self: Let this be a lesson to always check the reviews even if you are in pain.  Waiting a few minutes to see which place would be best is worth it.

[unsinkable]

I figure I will report it (many people IRL at the ER and also who have gone to that UC and seen that doctor and had bad experiences with him have encouraged me to).  Thank you to those who provided links on where to report.  The powers that be can decide whether they should take any action.  I know this doctor has had at least two complaints lodged against him by people I know (of course this is something you don't find out until after they hear what happened to you and then they tell you their experience!).  I'll probably send a copy to the insurance company, too, since he's a preferred provider with them and maybe put a review on-line.  The really weird thing is according to their website they DO do sonograms and x-rays, but they told me while I was there that they don't (it also says they do stitches but they told my friend they didn't do those either).  That's kind of strange.

 

ETA: I just looked at some reviews.  He gets BAD reviews.  Lots of them.  And most are very similar to my complaints.  Note to self: Let this be a lesson to always check the reviews even if you are in pain.  Waiting a few minutes to see which place would be best is worth it.

 

I'm reading your ETA with the "and now you know" music from NBC playing in my head...

[Jean in Newcastle]

I'm glad that you have had the surgery and don't have to go through all this pain and misery again!  

[Butter]

I'm reading your ETA with the "and now you know" music from NBC playing in my head...

 

Yup!  Hopefully that information can help someone else in the future.  We live where there are 3 hospitals and about a dozen urgent cares within 5 miles.  If I had gone another 3/4 of a mile from the one I went to I'd have gone to a place that lists gallbladder problems in their "things we treat" list and gets almost all 5 star ratings.  Of course that UC is always packed with long wait times while this one is not and has almost no wait most of the time.  But, yeah... to anyone needing medical care... use Google about the provider you are going to see before you go!

[Alice]

When I think about misdiagnoses I think it falls into three categories: 

 

1) Mistake by a competent physician- This happens all the time. Sometimes it's because more information becomes clear over time (which may not be a true misdiagnosis but is often perceived that way by a patient). An example might be a person who comes in with a bad headache for a day. The doc thinks possibly new onset migraine or stress headache. That same patient coming back two weeks later and seeing a different doc with the story of severe headaches daily for the past two weeks that are getting worse and associated with vomiting now may warrant a CT and be diagnosed with a brain tumor. Many patients would see the first doc as having made a wrong diagnosis, which is true but understandable given the change in the story. 

 

Sometimes a diagnosis isn't clear. Probably doctors should be better at saying "I don't know" but it is really ingrained in the medical training not to admit uncertainty. 

 

Sometimes good doctors make mistakes. We can be busy, tired, sick, thinking of something else or just human and make a mistake. Every doctor, whether or not she is  wiling to admit it, can think of those handful of cases where she made a mistake but thankfully it was corrected somehow. 

 

2) Incompetent misdiagnoses but that don't rise to the level of malpractice:

The line between incompetence/negligence/malpractice are not exact. But as in every profession, there are good doctors and bad doctors. A bad doctor might not take a good history or might ignore what a patient is telling him or might not be up-to-date on current knowledge or just might be lazy. I see what I think is bad medicine frequently being practiced in Urgent Care settings. 

 

3) True malpractice 

In my mind this is a misdiagnosis made when a doctor fails to do or does something that is outside what would be expected or done by other physicians in his place AND causes injury to the patient. Let's say I give you a medication your chart says you are allergic to but you don't have a reaction. My understanding (not being a lawyer though) is that there is no harm done so no legal malpractice. You might not come back to me ever as a doctor and you'd have that right, but it hasn't met the standard of harm done. However, if I gave you a medication you are allergic to and that was clearly marked on your chart and you have an anaphylactic reaction and end up in intensive care, there is clear harm done and therefore malpractice.

 

You can report this doctor if you feel strongly. You can report any doctor to the state Board of Medicine. Someone up thread mentioned restaurant reviews online, there are tons of sites to review doctors online and you could use one of those if you feel strongly about your care being poor and just want to get the word out. It sounds to me like you had a bad experience and at the least, the doctor was unprofessional. Whether or not that rises to the level of censure or malpractice is a different story. You can report, but that doesn't mean there will be repercussions for him. 

 

As for the HIPAA violations, I'm not sure if what he and the nurses did was illegal or again just unprofessional. HIPAA is a confusing law and open to a lot of interpretation. Yes, you could have figured out which patient he was talking about but that is different than him using the patient's name. If you feel strongly that this was a violation, you can always report it. I don't think him calling the ER was a violation, I call frequently to check on patients of ours who are in the ER. You could also view that as good follow-up care. His tone or manner might have been weird and been what made the ER nurse seem to think he was creepy but I find that part of the story pretty normal. 

[kathkath]

I'd post on yelp.