Dealing With Doctors

Oh, Paul...

First: happy to hear you are well. Sincerest thoughts for your continued good health.

2nd: you obviously enjoy the soapbox offered by PAO, as do many. I appreciate your posts.

But geez, man, you sure open yourself up to the small but determined cabal of posters that see you as a red flag to their bull... (the reader may decide whether the last word is sufficient as is, or requires a few more letters.)

Lastly: interesting observation, and fascinating discussion point. In so many ways, we are blessed by Stanford and it's medical bounty. I have also experienced both ends of the spectrum: the wonderful Winston Vaughan, M.D., literally changed my life immensely for the better after some botched sinus surgery performed by another. Yet I can echo the downside of being in a teaching hospital as well.

be well...

Duh, don't go to a teaching institution if you don't want trainees. They have to learn somewhere and being that you have extra time on your hands to post blogs, it's good that the attending doc was teaching the resident, who might eventually become a staff physician at Stanford. That said, teaching institutions are on the cutting edge while private practice physicians may be practicing old medicine. That said, we can't attract the best physicians here due to the high cost of living. Physicians in other parts of the country are being paid the same salaries as those here but their cost of living is much less - a much more financially comfortable life.

Poor Paul, it's always something-- cars parked on your street, construction n your street, not doctors. Life is so hard for you.
Patients also need to learn how to communicate with doctors, I.e not expecting the doctor to figure out what is wrong with you if you do not say what ails you.

right on cue....

To the prior poster,

Thank you for reading some of my postings. No thank you for apparently missing my larger points.

I am expected to make observations about what is going on in the community. I use personal anecdotes and experiences that apply to many in these parts. It is a commonly accepted technique for those who write for public consumption.

It is up to you whether you read my observations or not. It also is up to you to think more expansively about what I am writing.

Cut out the "poor Paul" nonsense. I am not complaining. I am observing and find amusing when folks think this is about me, and seem unable to think about the larger questions I pose.

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I have had four extremely bad experiences with Stanford Hospital, including one in which I was brought in unconscious. I fired all my docs who were connected to Stanford--that means PAMF, Welch Rd docs, anyone north of Mtn View or south of RWC.

I totally lost it with them after one of my friends was kicked in the gut by a two-year-old colt, and bled to death internally while waiting seven hours in the emergency room.

Never go to a teaching hospital if you are in need of expert care....Stanford is among the worst.

"I am divorced from a Stanford trained MD."

How much does this statement influence the rest of what is written by Paul? I prescribe therapy.

Its telling all up front, both good and bad. Rather he not disclose it? You are one silly md.

One thing Stanford brings to the area are clinical drug trials, both good and bad. Did one, worked for me when nothing else would. Am convinced I did not get the placebo. Now, if I could do something about this darn twitch........

Well, folks, you can poke fun if you want, but you do miss a valid discussion.

As a Registered Nurse, graduate degree, decades of experience, etc; etc; I can tell you that if you think you are completely safe @ Stanford, or ANY hospital in the bay area, you are sadly mistaken.

No matter how competent your private M.D. may be, when you enter a hospital, you will be taken care of by a team of "hospitalists." Good luck with that, as the saying goes.

Medication errors are scary common. Residents today are more like mechanics for the human body. They can't think without their hand on their smart phone or such device. Absolutely no compassion, or people skills. None.

And if you think Nurses are going to save your butt, sorry about that,too. The quality of nursing education has been so dumbed down it is pathetic.

Your best bet? Hire a clinical specialist R.N; in the area you need, to be your private Nurse while in the hospital. And make sure she is not foreign trained.

I understand Paul's post. I've had the unfortunate experience of being in & out of the hospital recently. I was at at PAMF & transferred to Stanford both times & both times received excellent care all around. The nurses, nearly 100% of them, did an excellent job. Most of the CNAs were quite good. The doctors were busy but thorough & I think the hospitalist I had the 2nd time was excellent. In fact, other medical staff told me how good & beloved he was. My surgeon & his team were also very good. Apparently, residents love this tough surgeon & I was well taken care of. Kudos to my anesthesiologist who proved his expertise.

While the ER can always hit or miss, & the residents often annoying when you're in severe pain, it could've been much, much worse. I expected a bit of confusion, changing staff & patients in more dire straits but I didn't experience any dangerous or frightening mix ups.

Whenever possible, have someone as an advocate when you're in the ER, as well as during your hospital stay. I'm lucky to have medical professionals in my family who helped, but they weren't there night & day. I was deeply impressed especially by the nurses - how hard they worked, their knowledge, professionalism, kindness & medical etiquette.

While a couple of times I suspect some of the docs were a tad condescending, I made them explain themselves so that I learned instead of assumed - it helped me & they instantly refined their bedside manners.

The noise of a teaching hospital & the even greater lack of privacy is hard to take. OTOH, residents came to check on me w/out their fearless leaders & while I know to them I was just a case, I did get more questions answered, even if it cost me more rest.

The only overall annoying professional amongst so many, was a male RN in the ER who kept asking me how he could help when even on meds I complained about severe pain. How could I answer that questions when I didn't know the answer?

I was told numerous times that I was an easy patient - I asked good questions & know enough about medicine, anatomy & physiology that I was able to understand what was going on. Once I knew I wasn't going to die (seriously, that was a concern that first time), I was able to focus on other things, such as being cooperative & advocating for myself.

I was actually surprised at how good my experiences were because like many of you, I hear horror stories & I've met my share of crappy medical practitioners.

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Believe it or not, hospitals are pretty democratic when it comes to treating people. Maybe that's what's eating him. And if Paul's ailments were judged to be less serious in triage mindset, than he gets pushed to the back. It sounds to me as if Paul did a poor job representing himself. If the MDs offered perspective on an issue which he claims was "misdiagnosed" than Paul should have offered up his competing hypothesis and medical opinion.

And who's to say that there is not a lot on the mind of physician he just dealt with to justify his manner? How many lives is he responsible for? How many residents is he responsible for? I wouldn't be so quick to judge.

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I have twice been in hospital (not Stanford) and had trainees taking part in my care. I had high risk pregnancies so was a good candidate for being used as a classroom patient. I always found them really polite, eager and personable. In fact I would say that I felt as if I was getting extra care as their questions made the teacher spend more time examining me or listening to me. I think it is down to attitude of the patient. I felt part of the class rather than a piece of meat being examined, I remember a lot of laughing.

It is a fact of life that medical personnel need to examine patients and they can tell if you are accepting of their presence. I expect they feel a lot more comfortable with patients who are on their side rather than antagonistic about their being involved.

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Mommy - thank you for putting into such apt words my similar experience w/residents. We also laughed a lot, which was really nice, given the circumstances. I was also part of some resident interview process where they had to assess patients via an oral interview. The senior prof/physician w/the resident was a hoot & they were very sensitive & respectful.

I also appreciate all the medical staff managing to ask me difficult questions in a sensitive manner, as well as bring up touchy subjects with aplomb & wisdom. Maybe I was just lucky w/my experiences, but I was able to even get along well w/the docs who seemed touch curt. I appreciated the overall medical etiquette that I experienced.

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The last time I was treated at the Palo Alto VA facility it was the same thing. It appears it's another venue for teaching Stanford medical students. "An affiliation with the Stanford University School of Medicine provides a rich academic environment including medical training for physicians in virtually all specialties and subspecialties. Over 1,300 university residents, interns, and students are trained each year."

Web Link

I'm a longtime Weekly reader but new to this blog. Question to all: Is this a typical post? Question to Paul: What is the purpose of this post - if you are unhappy with Stanford Med School, then it's best to move on to an new provider without posting a blog entry that ranks with Fox News. [Portion removed by Palo Alto Online staff.] I hope that future blog entries have actual content value.

The amount of censorship here, and uneven incompetent censorship has increased to the point that it is more infuriating than anything else to even come here and read ... excuse me, try to read any intelligent people's postings - agree or disagree.

Can someone restrain the editor, or fire them and find someone with some degree or objectivity or professionalism, please?

When someone posts a nasty or humiliating comment - delete it, not the attempt of the attacked person to defend themselves ... you are crazy-making, and that means you are not being productive.

As I see it the purpose, at least to me, or this post was to point out something that I experienced at Stanford Health Care - and out of control corporate bureaucracy that if it considers patients at all, certainly does not put it first, nor very sincerely.

How is it in my searches for a doctor at Stanford I went through three of them trying to get a routing yearly physical, and they gave me no tests but a blood test?

How is it that all my medical records seem to disappear or cannot be found leading me to have to get duplicate tests, and I wonder what they do with the results of these tests since they are digital ... do they delete them so in the future is something was missed they are not liable.

Finally, I realized with Stanford this was chronic and seemed to be purposeful with some kind of guiding principle of dehumanizing the patient - and I left.

I am not that much concerned with interns being called in to observe something, but then I never had anything that was touchy or serious. One time I was prescribed to take an MRI and found out that they were doing a study at the same time as my test which lengthened the test by some amount. That bothered me.

There are many variables in health care, and we have all been sold what more or less is a bill of goods by stories in the news or magazines about medical miracles, while at the same time the medical industry does not stand up and attack the food industry as the prime cause of people being sickly and obese.

There are many good books out there about the medical industry, I can recomment the author Atul Gawande and his three excellent books. Jerome Groupman is another author who writes well about medical subjects.

The money people have taken over health care, and they micro-manage doctors to such an extent that we cannot even blame them, they are handcuffed by regulations and "best" practices that mostly revolve around minimizing liability and maximizing profit.

My experiences with Stanford were very unhappy. One shining contrasting good example was my Mother's recent hip surgery at Stanford by Dr. Goodman where everything went very well, thank God.

I could never recommend Stanford Health Care to anyone ... and in general am very unhappy with most of the health care institutions I have had any experience with, again, aside from Planned Parenthood that do a spectacular job with the sparse resources they have.

We all need an attitude adjustment when it comes to medicine, there is a lot known and a lot of amazing capabilities, but the human side and the application/practice side is extremely uneven.

Just weighing in.

As a recently retired ER nurse, I agree w/ "MD" who stated that, "...hospitals are pretty democratic about treating people...", and that if a patient doesn't tell the doc everything, perhaps intentionally holds something back that's embarrassing or, worse, to see if the doc can figure it out, and then pounce when he doesn't, the patient (pt) gets what he gets. You make choices as a pt or as a doc, you need to own the consequences.

I do not, however, agree w/ "MD"'s statement re excusing poor interpersonal skills and focus because, "... there's a lot on the mind of the physician." If the physician is too distracted to pay attention to the pt in front of them, he/she needs to take a break and come back when they CAN focus. O/W, mistakes happen, diagnoses are missed, inadequate labs get ordered, negative outcomes occur. There is no excuse for inattention in medicine. None.

My experience picking up a friend's mother in the step-down unit by Stanford ER was unimpressive. She was dressed, off the monitor and BP cuff, IV out, had eaten, labs were back and discussed, and she had been told she was ready to go, yet we still waited 2 hours for discharge. The nurses came and went, but the doc, who had been and gone, sat at the nurses station chatting with another physician discussing politics (hospital politics) off and on between very brief checks on other pts - for 2 hrs. I had to become quite assertive and create a bit of a fuss in order to annoy them into discharging the pt. Something non-nurses might hesitate to do. Priorities are clearly skewed, and their unabashed attitude was, who did I think I was interrupting their very important discussion. I don't know if pt's are charged by the hour, level of care, or by the procedure in that unit. Physician arrogance is certainly not unique to Stanford, but it is clearly alive and well in that unit.

PS to "Frank": I have received care second to none at the Palo Alto VA. Excellent communication between physicians, myself, and ancillary departments, prompt service, kindness/compassion, intelligent discussions (not talked down to), questions are encouraged, referrals offered and arranged, no rush to get to the next pt, clear follow-up instructions and appointment reminders, free classes on everything from healthy eating to exercise support ... not a single negative experience in 3yrs, but lots of positive ones! Even if they ARE associated with Stanford.

One of the many reasons I became homeless was healthcare insurance, which I didn't
didn't have, after divorcing my engineer husband. I paid out of pocket untill could not pay any more. Health care is a scam! Today I go to free clinics; everyone is welcome . There is one in Half Moon Bay; and heard there is one in East Palo Alto. There is always one professional doctor there to see and they see everyone on line. A real Doc! The staff treats everyone with respect, no bs. I recommend trying this free clinics . Last time I went I had poison ivy very bad and got immediate help from these wonderful volunteer doctors. I was treated with respect, and they even had donuts, coffee, orange juice, milk and other snacks for people suffering.
I found out most body pains heal by themselves . Today I pray every day for health, because it comes first; including mental health.

Wow Paul. Kinda harsh my friend. I hate to see what you think of lawyers and dentists!

As several folks already said, if you don't want all the trainees, don't go to a teaching hospital. Also, ALL large institutions tend to be frustrating to deal with. Ever try to get anything processed in a large University? Or get a need document from a municipal, state or federal government? Or perhaps deal with one of the larger banks? I could go on, but I think I made my point which is NO ONE seems to ever be trained to focus on the customer (or patient in this case). Solution? We need to be take responsibility for ourselves. I have to admit that I don't have a lot of sympathy for your inconveniences. But I do feel very much for the elderly and severely ill who don't have the strength to fend for themselves in hospitals, banks, retirment homes, or anywhere else. So, perhaps if we all stop whining so much and instead focus on helping others through the processes, things might get better. Do something positive with your frustration - volunteer at Stanford to work as a paient liason. Much better use of your time than complaining on a blog!

I've been seen at teaching hospitals at Washington University in St. Louis, University of Chicago, and Stanford. The inhumanness of the Stanford folks is in a class of its own; they are truly depraved as a culture, it seems. Wish there were something I knew to do about it besides commiserate online and warn anyone I talk to, but for now I appreciate Paul highlighting this issue and commenters taking the time to respond. Stanford Hospital is a shame on this community and on Silicon Valley. Maybe the PA Voice can do some investigative journalism to try to get to the roots of why.

(Sorry, PA Weekly!)

Re: Disclosure and drug trials

"Am convinced I did not get the placebo"

"Did one, worked for me when nothing else would."

PLEASE PLEASE PLEASE write more - you're on such a roll.

Geez! I just remember meeting one of the-- victims-- of Stanford clinic. Spoke with her 2 weeks ago when I was having lunch in one of the area soup kitchens. We sat across each other and she right away started to talk to me about Stanford health clinic and how she had been misdiagnosed and more or less ' butchered' with wrong surgeries. And she was not still well, had been inbound; housebound for months and was still using a cane, if I can recall correctly. Basically had no idea about clinic having issues at that time and others coming forward with similar issues.Definetly will share these on line concerns with her if I see her again, at least for her to know she doesn't seem to be the only one.

I was married to a Stanford medical trainee at the time I delivered my child at Stanford. My OB had to throw the intern and residents out of my room when one of them INSISTED that he conduct an exam on me because "After all, this is a TEACHING hospital, and you as a local physician, should underSTAND that!" . . . what my OB understood is that it was highly inappropriate for my husband's colleague with whom he worked every day to get anywhere near that close to me! :-) Gotta love my OB's response . . . "You! and You! and You! . . . OUTTA here, NOW!"

Now can we hear from the 100,000 satisfied patients. Are they all wrong?

If you have to go to a teaching hospital, never go in July. A lot of the residents will be totally new. As the saying goes, Stanford is a great university with a mediocre medical center. The hospital ratings came out this week on the safety of our area hospitals. Stanford got a "B" grade, and that is no surprise. You can go into Stanford hospital with something fairly minor and end up very very sick. Avoid hospitals by taking good care of yourself and practicing preventive care.

Check this out by entering your zip code: www.hospitalsafetyscore.org

Will never go there after reading all these comments. Sure, it might be a great university if someone has lots of $$$ to get in. I'm just surprised about all these comments about the health clinic, not that I have ever been there. If Stanford is so great why don't they use real guinea pigs in medical training , people are and must not be treated as guinea pigs. Or maybe they do use guinea pigs? They dont talk though. And maybe medical education and training is lacking or is weak in the social communication? No one should feel dis respected after seeking advise and treatment for medical issues. In a nut shell summary: all medical trainees must have social skills along with their expertise.

To Author: good thing you fired the doc and the team! You did what you felt was right for you. There are good docs, and bad docs, good engineers and bad one's, and good attorney's and bad ones! I fired my divorce attorney and what did he do after ?He went to appraisal district claiming I had sold my house to him. He stole my house by falsyfing legal property papers. Ever since firing the attorney... which is about 4-5 years I struggled with homelessness . I learned a lot about this: being assertive is a skill often missunderstood . People, who are strong within share their life experiences with others to learn vista vis your article is great Paul! Can't wait to see what you ponder; write about next. Excellent!

@mmmmMom:
Your comment about foreign-trained is incredibly uneducated.
Some of the best medical professionals here ARE foreign-trained. Same goes for engineers.

Are you merely concerned about the impact on your wages? Or is there a racial bias?

You also contradict yourself when you say that nursing education in the US has been dumbed down. Then again, you are the product of such a system...

Today; would walk out if I saw a doc or any medical staff i would not feel comfortable from intuition ! Would not give them a chance to be fired. They could be psychopaths; health clinic is an ideal work place for them to be situated. And so are ambulances; Medical trainee; who is psychopath ;could easily suffocate a person on the way to the clinic. This is not a race issue. Topic is abou trust and being assertiv when a person; patient is not only sick, but has to deal with untrained rude staff from Stanford quartes.

Today; would walk out if I saw a doc or any medical staff i would not feel comfortable from intuition ! Would not give them a chance to be fired. They could be psychopaths; health clinic is an ideal work place for them to be situated. And so are ambulances; Medical trainee; who is psychopath ;could easily suffocate a person on the way to the clinic. This is not a race issue. Topic is abou trust and being assertiv when a person; patient is not only sick, but has to deal with untrained rude staff from Stanford quartes.

Some other thoughts.

When you agree, as I did, to some examination totally unrelated to my reason for being in the hospital, it is good, as I did as best I could in a medicated state, to attempt to work with the doctors. The complicating factor from a patient's standpoint is that the state of mind is not normal, and I felt my advantage was being taken.

On a more whimsical note, this team that swarmed on me for reasons that had nothing to do with why I was there requested that I go in for an MRI. 60 minute procedure inside a very noisy machine.

I recommend singing Beatles songs to your self if you ever are subjected to such a procedure.