Your Practice, The Auto Repair Shop, and Missing Information

Last week, we talked about healthcare and the airlines. This week we’re going to talk about healthcare and auto repair.

Imagine there is something wrong with your car. It’s making a funny noise, there is a bit of smoke when you pull out from a stoplight, and your mileage is off. You take it to your mechanic - let’s call him Fred - and he looks at it briefly and says you need to take it to a testing center across town.

You tell him you think you recently had some tests done in the last year, maybe with another mechanic or another testing center, but Fred can’t seem to find any record of those tests, and they are probably different or out of date anyway. Since you can’t produce the tests (since you didn’t get the result) he says you have to have the tests.

It takes you a couple days to arrange your schedule and get an appointment. You arrive at the testing center - let’s call it Joe’s Auto Testing Center, or JATC. Fred, your mechanic, was supposed to fax over something to Joe telling him what he thinks is wrong with your car, and why he referred you to JATC, but it didn’t arrive or Joe can’t find it, so Joe hands you a clipboard and asks you to fill out your entire mechanical history of the car. He also asks for the history of all your other cars too. You explain that you only care about this current problem with your current car, and after some negotiation he lets you off with just requiring the history of your current car.

You get the test done and you ask Joe what the problem is. Joe says he can’t tell you, but he will send your test results back to Fred “in a couple of days.”

In the meantime, you are driving your car around with quite a bit of anxiety and paranoia. Is it just low on oil or is it time for an engine overhaul? You run through all the scenarios and wait impatiently for two days.

You call Fred, and he’s not available and will have to call you back. He calls you back a day later, but he says he hasn’t gotten the test results back. You call JATC and they say they sent the results to Fred. You call Fred and talk to one of his assistants but they say only Fred can give you the results. You leave a message. Fred calls you back but you’re not available so he leaves you a message. After 2 or 3 days of this phone tag, you finally call at a time that Fred happens to be available, and he tells you your car needs a new head gasket.

Does this sound insane? Maddening? Incredibly inefficient? Yet this scenario is played out every day in healthcare, where a patient has to go from one provider to another, or from a provider to a testing facility, or from a provider to another clinic or facility. At every new boundary of care, the patient has to start over with their health history. The results from external tests and procedures can take days or even weeks to find their way back to the referring physician. And it usually takes multiple attempts for the patient to connect with his or her test results. With all the phone calls, inquiries, callbacks, and trying to track down the test results and communicate them to the patient, the inefficiencies for both the patient and the provider (and the provider’s staff) are astounding. Why do we accept this?