The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Virtual Book Club

Another chapter done!?! {WOW!} Are you not working? So you know, now that you forced this virtual book club on me I think it is pretty cool to talk about what you are reading, as I do not read, and the fact you get my message is pretty cool. So although I was screaming and kick, I would like to say thank you for getting me to see another side of writing. By the way, I am going to post this discussion on the blog too. [Reader's word] {Words I added after my email reply to reader}.
Now, if I am following correctly, your next chapter is "The Numbers". I think that is the most difficult chapter to follow as it has, well, a lot of numbers. The chapter's point being, what numbers really matter and that any number can have a polar opposite significance although it is the same number. Crazy! But those are numbers and one would think if anything is concrete it would be numbers. Not the case.
[p 124- interesting about shoulder dislocations; will you teach me on our next medical mission?
p 125-loved the comparison to what you did in Guat. without sedation, meds. etc.  great example...]
I just tried to reduce a shoulder two weeks ago {without sedation} but the patient did not tolerate it and the only one who was upset was the physician because he did not want patient's suffering {he said}. Although the patient consented to try without sedation and after it was reduced with sedation the patient apologized for not being able to tolerate it without sedation. Of course, I told the patient there was no need to apologize or to think anything less than it hurts. The moral is after you read those stories, on more than one occasion, that it is possible to reduce a shoulder without sedation. However, as you read, some patients may tolerate it and some won't. And to me that is no different than patients tolerating or not tolerating any other procedure, like a shot or exploring a wound. By the way, giving credit where credit is due, {a friend} taught me that technique and it was {other friends} who put that shoulder in, in Guatemala, not me. But sure I can show you, but the biggest huddle is getting the patient to trust you.
[p 128-loved your analogy about the patients being called back like a hotel or hospitality check when in reality we should only be calling them to see how they are?  Totally agree with this; when did healthcare become like the retail world? 
p-129-agree the good survey responses are never shared with the people responsible for getting the great scores; just used for marketing persons when the healthcare workers should be getting the pat on the backs...
p 133- agree totally -we should be only calling them back to see how they are doing; not to survey the visit; what has healthcare come to; exact reasons I am discouraged from taking care of patients at "big" hospitals; loses the personal touch]
Patients are rarely called back to see how they are doing. Yet are called back to complete surveys all the time. Crazy!
I do not ask for pats on my back {nor do most healthcare workers}, however, when a patient complains the "adada boys" are never taken into consideration. Not that patient complaints really have any grounds, either. Of all the patient complaints you read about in the book, when you find one complaint with merit let me know. That challenge is to anyone, to include any patient that reads the book. I would even step out on a limb to say the same about any complaint about the airlines.
[p 131-so true about the gal on the cell phone getting sutured up; do you think they can hang up or call them back?  frustrating to me!  So true about the blind exploration and what the stats show about making it worse so not to do it and then have them f/u with a specialist, etc.  The administration should've read the medical chart.]
The retain foreign body patient did not complain. The issue was the patient could not afford the follow care and my employer could not convince three of his colleagues to see the patient yet my employer tried to make it an issue of mine some how.
[p 134-Got a big chuckle about the family plan; as I never thought about it that way and by george you're right!  Wow!
p 141- loved how you said: "they get a free estimate" of their medical complaints...]
Family plans are no more than "visits of convenience." Regardless if in ED or FP. I cannot believe you never heard that before. Glad you found it funny. The write up was a lot longer but the editor commented it was to much detail so I cut it back significantly. For me, the funnier part was the assessment, diagnosis, care plan, and follow up was the same for all family members, but the parent did not get that because unlike the children the parent did not get a definitive diagnosis. And the parent did not get a definitive diagnosis for no reason other than the parent did not meet the financial requirement. However, the parent was okay that the children were given the same assessment, diagnosis, care plan, and follow up instructions. I just could not find a way to let the parent know they got a FREE ESTIMATE! VERY CRAZY! 
[p 137 on -trying to figure out the MSO.  Does this have to do with whether the patient's insurance company will pay for their ER visit by the way it was categorized?  I know that our insurance has a ER co-pay....does this main it would depend on whether it was an emergent vs. non-emergent care to be covered or not?]

MSO (Medical Screen Out) is a fabrication of administrators for no reason other than to improve their payer mix and that is why it makes no sense to anyone, to include the administrators who implement it. EMTALA requires a Medical Screen Examination (MSE) of everyone that presents to the ED and it has always been part of EMTALA. I would not say MSO is MSE resurrected because MSE was never entertained {as a separate entity} until recently and in the past everyone presenting to the ED was seen regardless their complaint, even the soft palate avulsion from a Doritos. From what I understand, and I could be wrong as I do not do insurance but do healthcare, insurance payments are based on the final diagnosis and not any other criteria, to include MSE. Hope that helps. If not, I would have to share the explanation with you at another time.
[I think administration is wrong about you; you are an asset if they would just take the risk and stand with you to patient complaints!
Until the next chapter.]

Ah, that was so sweet of you to say I am an asset; that is commonly what I hear. However, it is administrators that need to realize that. Having said that, there have been some administrators who also believe I am an asset but they were chastised when those administrators stood with me and I understand, I cannot expect anyone to risk their job for mine. But I appreciate there are others out there who side with me and I hope that I have told their story as my time has passed. Send more brains, Jose.

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