Friday, July 2, 2010

A story

Yesterday, while I was wondering around the grocery store in a post call stupor, my pager went off. Every patient I had seen on morning rounds was stable but there were a new group of residents on duty, so I quickly dialed an unfamiliar number.

"Pathology, Erin speaking," said the chipper voice at the other end. When I identified myself saying I had been paged, she replied, "Yes, Dr. P wants to speak with you."

A very formal Dr. P now on the other end of the line says, "Do you remember a woman you saw in the emergency room on the 28th, M.C.?"

I could remember no such person. "Did she have a D and C or an ectopic?" I asked.

"I can't tell," Dr. P answered. "All I have on the pathology slip is products of conception."

"I know I did NOT admit her to the hospital. What night was this again?" I have been on call 3 of the last seven days. Actually, it has been 4 of the last nine so everything has run together. The name is Hispanic and one night the theme was 'I am very sick and I do not speak English.'

We determined she was in the emergency room on the 28th but never seen by me or one of the OB-Gyn residents. The patient was given my name to follow up but I had yet to have a call from her. Not necessarily a bad thing since it had only been three days but I had to get to a computer and see what phone numbers I could find for this lady who might have a molar pregnancy.

A molar pregnancy is where no fetus develops and only placental tissue grows. This tissue can even spread to other organs such as the lungs and the brain. Patients can get very sick, bleed a great deal, even die if they don't receive appropriate treatment including at times chemotherapy.

Later, at home, I get on my computer and find the patient information. Reading through the emergency physician's notes I see where he saw her and referred her to me. Looking at her patient information I see that she does not have a social security number. She is an undocumented alien.

There is a home number, a work number, and a husband's name and work number. I call the home number first. A man answers. Identifying myself I ask to speak to the patient. He hangs up. Not, "Sorry, you have the wrong number." Just click.

When I can the work number and ask for the woman, I am told I can only leave a message, which I do. Finally calling the husband's work number I speak to him. He understands English but tells me he is not allowed to talk at work and hangs up.

Sure enough, the woman leaves a message on my voice mail from the cell phone of a co-worker who speaks English. I am able to call back and talk with her and make arrangements for the woman to be seen. Is this a HIPAA (Health Insurance Portability and Accountability Act) violation? I doubt it but I worry a bit that I have divulged all this information over the phone to a total stranger.

I am also very upset that the emergency room seems to take no responsibility for the follow up. I understand the task of follow up is over whelming. Even in private practice, where patient want their test results and call daily until the results return, people fall through the cracks. Here I feel as if I am sitting on something bigger than the Grand Canyon with very few resources.

I don't know what the answers are to health care access or to people who are in this country illegally. I do know where these two issues intersect it is extremely difficult to get anything done.
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