As I See It

Respect the pros

In this case, it’s not the MDs; bureaucratese is a fact of medical-practice life.

By Paul S. Koch, MD, Editor Emeritus

There comes a time when the doctor needs to dispassionately step away from compliance issues and let the pros take over. We have such a pro in our office who has been proving her proficiency for 15 years, and I must remember that she is an expert.

This story begins with a patient in our office who had to go to the bathroom. Admirably, when finished with her necessities, she washed her hands using hand sanitizer.

Unfortunately, she somehow managed to squirt some hand sanitizer into her eye. She came out of the bathroom screaming. Her doctor saw her right away, evaluated and treated her. Everything was documented in the chart, beginning with the statement, “Patient squirted hand sanitizer in her eye and now her eye is burning.”

You can’t make this stuff up

We thought that might be the end of the story but alas, no. She wrote a letter to a regulatory body complaining that we did not have a sign in our bathroom advising people not to squirt hand sanitizer in their eyes.

The regulatory body people did not ask us for records or input, but they also did not hesitate to send us a letter of reprimand describing findings of their “investigation.” Among the so-called findings was this: “There was no documentation of the incident.”

Here I refer the reader to the paragraph third from the top, the last sentence. There followed other demonstrably false statements and a demand for a corrective action plan.

Breathe deeply, and count to 10

I drafted a letter, the kind you should wait 48 hours before sending. It read something like this:

“You arrogant, pompous, blind idiot. What kind of fool claims there was an investigation when there was none? Could you not read [see pargraph third from top] but wait, you never asked to see the chart so you obviously had no intention of seeking the truth. The fact is — all your so-called findings are false and therefore there IS no need for a corrective action plan you ….”

I showed the letter to my liaison. She thanked me profusely and said she would just make an edit or two. Here was her final draft in totality.

“We appreciate your concerns. Attached is the corrective action plan you requested.”

The agency replied, “Our medical director was extremely impressed with your response and accepted your response quite happily. If only everyone responded so proactively!”

Stop making sense

So, what did I learn? I learned that the regulatory agencies and our liaison have expected behaviors that make it easy for everyone to cross T’s and dot I’s. They had to respond to the complaint with enthusiasm; we had to demonstrate we were cooperating to improve quality. It’s not personal. It’s a protocol.

I already knew that certain letters should not see the light of day for 48 hours, and now I am reminded to get out of the way and let the experts do their work.

I’m still trying to figure out how that patient figured it was our fault that she squirted hand sanitizer into her eye. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, R.I. His e-mail is pskoch@clarisvision.com.