Can’t you make the doctor see me or do this procedure?

Some common complaints we hear in Patient Relations include complaints from patients about doctors declining a referral sent by their family physician for specialist treatment at one of our hospitals; patients requesting to be referred to another physician for care because they disagree with or feel they “don’t get along” with their current physician; and patients who want hospital administration to tell a doctor to perform a procedure or test the doctor has said he or she will not perform. When speaking with patients about these types of concerns, I have realized that patients are not often aware of the position of doctors in relation to the hospital and in relation to patients. I must admit that I wasn’t either, before I started working for UHN!

Patients are often surprised to learn that a doctor is allowed to decline a referral and not see a person who would like to be a patient. Common and permissible reasons for this include that the physician or surgeon has a full patient load and cannot accommodate more patients; the treatment the person needs is outside of the doctor’s “scope of practice” or “clinical competence” (i.e. the doctor does not practice the particular kind of medicine the person needs or isn’t an expert in the area); the person lives outside of Toronto and can receive equivalent care at a hospital or healthcare centre closer to their home; and, the person is already being treated by a competent doctor in the area of practice. While patients do have a right to request a referral to another physician or surgeon if they are unhappy with their care, there is no guarantee that another physician or surgeon will agree to accept the person as a patient, and no guarantee that there is another physician or surgeon who is appropriate to take over a patient’s care.

Patients are also often surprised to learn that most doctors are independent professional staff who are appointed to work in our hospitals. What this means is that most of our doctors are not employees, and don’t have a “boss” at the hospital who can direct their activities. Most are paid directly by the Ministry of Health, not by the hospital. If a patient claims that a doctor did something that caused them harm, the hospital generally does not have legal responsibility – it is the doctor him or herself. All doctors are ultimately accountable to their governing body, The College of Physicians and Surgeons, which has policies doctors are expected to comply with.

That being said, the hospital does have a number of processes in place to make sure our physicians and surgeons are practicing according to standards of accepted safe practice. Each doctor reports to a Chief, and each Chief reports to the Physician in Chief or the Surgeon in Chief, depending on the specialty, as well as the VP of Medical Affairs. Patient safety is very important, and if a serious incident occurs, a review must take place.

If a patient has a complaint about their physician or surgeon that the patient is not able to resolve directly with the physician or surgeon, we in Patient Relations welcome you to speak with us. Sometimes we can assist with sorting out the issue a patient has with their doctor, and maintaining the patient’s relationship with the doctor. We can also promote education or remediation as needed, as the hospital does have responsibility for patient safety.

Patient Relations Stats

Each year, the Patient Relations department produces an annual report. This report captures all of the feedback (good and bad) we receive from our patients and families throughout the year and helps to identify problem areas and system issues to our leadership.
Below are some of the highlights from our 2014/14 report:

This year we had 3754 cases at Patinet Relations.
1613 of those were complaints and 600 were compliments. The remainder were inquiries, consultations and pre-emptive calls.

55% of our cases were resolved within 3 day’s time and 74% were resolved within one week.

The majority of our complaints are related to the areas of the hospital which treat the highest volume of patients. The same goes for our compliments. This is consistent with previous years.

We hope that by sharing our patient/family feedback, we can improve our practices and services at UHN. Thank you to everyone who has assisted us in resolving our patient’s concerns.

No room at the Inn

With patient volumes ever on the rise, hospitals in the downtown core are continually faced with the problem of bed space. We often have more patients, than we have beds. This leads to a number of issues; having to re-direct ambulances, having to temporarily place patients in hallways, Emergency departments overflowing with patients waiting for in-patient beds, and having to cancel surgeries. This is a well-known issue for the province of Ontario and its aging population.

As a result, we often hear from patients and families members who are understandably frustrated about the lack of hospital beds and the lack of private or semi-private accommodations.
Here are some helpful things to know:

  • If a patient comes to the Emergency department (ED) and is admitted to hospital, but there is no available bed on the unit to which the patient is assigned, then the patient will either 1) wait in an available bed in the ED, 2) be temporarily placed on another inpatient unit, or 3) be temporarily placed in the hallway on their assigned unit.  Though not ideal, each of these options are a temporary solution until an appropriate bed becomes available.
  • If a patient has requested private or semi-private accommodation, this is provided based on availability.  Patients requiring private rooms for clinical reasons (i.e. infection/isolation, imminent death, clinical equipment) take precedence over patients requesting private accommodation as their preference.  **It is important to note, that if a patient has been placed in a private room in accordance with their preference, they will be moved to another room if a patient later arrives to the unit who requires private accommodation for clinical reasons.

Without the ability to predict how many patients the hospital will receive, and without the ability to predict if/when inpatients will be medically safe for discharge, the issue of bed-space continues to require our attention and problem solving.  We will continue to work collaboratively with our patients and families to provide care to all who come through our doors.

Mixed Gender Hospital Rooms

The subject of mixed gender patient rooms is a hot topic for hospitals right now, especially given the ever increasing patient volumes in Ontario and the limited number of hospital beds available in acute care facilities.

This recent article out of the Sunnybrook hospital addresses the debate:

http://healthydebate.ca/2013/10/personal-health-navigator/would-you-share-a-hospital-room-with-opposite-sex

 

Please leave your valuables at home

This is just a reminder for our patients that when coming to the hospital, please do not bring the following items:

□ Valuables, such as watches or jewelry

□ Pieces of identification or credit cards

□ Large amounts of cash

If you brought any of these items with you when you arrive, ask a family member or friend to take them home.

Your money and valuables

The hospital does not assume responsibility for your money or valuables.

If you choose to bring money and valuables into the hospital, you do so at your own risk. If possible, please send all valuables home with a family member, friend or your substitute decision maker (SDM).

UHN will only assume responsibility for your valuables if:

1) You choose to have your small personal items locked in the hospital safe (such as your wallet, cash, credit cards or jewelry). These items will be collected for you in a valuables envelope. All the contents of the envelope will be written on the front and a claim check will be attached to your hospital chart. Security will lock these items in the hospital safe temporarily until you are ready to retrieve them.

2) You cannot take responsibility for your own valuables while in hospital. In this case, your healthcare team will be allowed to collect your valuables in the envelope, write down all items that went into the envelope and give it to Security for safekeeping on your behalf.

We know that you will have personal items such as clothing, medications, and personal support aids with you (for example, eyeglasses, contact lenses, dentures, hearing aids, mobility aids such as a cane, walker, prostheses or wheelchair, etc.). Please note the hospital will not assume responsibility for these items if they are damaged or go missing.

Thank you for your cooperation.

The Racist Patient

A recent feature broadcast on Brian Goldman’s CBC radio show ‘White Coat, Black Art’, tackled the controversial subject of racism from patients:

http://www.cbc.ca/whitecoat/blog/2013/09/16/racist-patients-an-enabling-medical-culture/

Unfortunately, this is not uncommon and we at Patient Relations get many patients/ family members expressing racist comments about all occupational groups when sharing their complaints. We also get requests from patients for healthcare providers of a specific culture, race or religion. 

The approach we take is that all of our personnel are fully qualified for their roles and we do not allow patients to choose their healthcare providers based on race or cultural backgrounds.  We encourage patients and providers to openly discuss issues/ concerns together and then make a joint decision as to whether each can continue the therapeutic relationship in a positive way.  If this is not possible, then perhaps another person can take over, if resources allow. The patient then has the opportunity to decide whether they wish to stay here or go elsewhere, where they might receive a healthcare provider of which they approve. 

When we are personally attacked without reason, the natural human response is defence or retaliation. As healthcare professionals, we cannot react this way, however we should certainly call the patient out on such behaviours and end the therapeutic relationship. This takes self-control and restraint.  Healthcare providers should feel empowered to draw the line with patients/ family members who behave inappropriately, however this needs to be done in a professional and respectful way, regardless of the behaviours with which we are faced.