the other side of defensive medicine

I wrote a stupid and annoying letter today.

The letter itself was very polite. But I wrote it because I was afraid, and that is what is stupid and annoying.

What was I afraid of? Being branded a "noncompliant" patient.

Why am I afraid of this? It's like a stink you can never get off.

What did I do that created this fear? I cancelled a followup x-ray at Radiology Department A because I don't have a doctor at Hospital A any more. All the rest of my local care is at Hospital B right now, so I wanted the follow-up to be done at Radiology Department B where all my other doctors are.

(Parenthetically, the reason that I don't have a doctor at Hospital A any more is that my doctor there quit Western medicine to become an energy healer, but that is another tale for another day.)

I thought I was really on top of things when I called Radiology Department B to get them to request all my films, scheduled the new appointment when the films arrived, and then and only then called Radiology Department A to cancel, explaining that the follow up was being done at Radiology Department B because they still had doctors practicing evidence-based medicine there and I had no clinician at Radiology Department A.

And then.

The next day I got an anxious call from Radiology Department A. We need to you be seen.

Well, I called and cancelled yesterday because I have the same appointment somewhere else. You just sent the records.

Oh. We don't have a record of that. It's very important that you be seen.

I explain again about my old doctor leaving Western medicine and my consolidating all my care to Hospital B.

This morning I checked on the EHR portal of Hospital A. Sure enough, they're still flagging me for overdue follow ups.

That's when I accepted: I'm in the Hotel California. Hospital A and Hospital B are, although nominally nonprofits, competitors rather than cooperators. There is no real system to track the transfer of care. Moreover, weeding out all flags from a big database is really, really hard. From their perspective, I represent a potential liability because they spotted a potential problem and recommended that I follow up. I get that. Unless I prove that the loop is closed they can deem me "noncompliant" and get rid of their exposure that way.

So I sucked it up. I wrote Radiology Department A a letter today, thanking them for all the lovely care (and they really have been nice over the years), reminding them that I have transferred care, and why, and enclosing a copy of the results of the follow-up x-ray from Radiology Department B.

Now that ought to do it.

Update: well, that was naive.

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