Vitals, Schmitals, Who Needs’em? by Sylvia Mustonen DO

You would think that something as simple and basic and obtaining a patient’s vitals would be the easiest part of a visit, regardless of the location, this is something all patients have done to them. But how many of them actually get their vitals taken correctly?

Coventry health care, which was acquired by Aetna in 2015 provides Medicare Advantage plan coverage to millions of older Americans.   In order to earn their money from Medicare, Coventry has to jump through a few hoops. One is to make sure they gather basic “health “ information on their covered population.   They do not use this for treatment, they do not use this for research, they do not use this for population data management, they do not share it with anyone, not even my personal physician. Their only requirement is to tell Medicare that all of their “people “were checked.

First they sent me a letter telling me of this wonderful free service. When I failed to respond, they started calling me to get me to sign up for a visit. I gave in.

So Coventry/Aetna hired a huge crew of nurse practitioners to go to homes and obtain a history and do a physical and report it back to Coventry/Aetna HQ.   Should we call them Caetna or Aetventry?

The NP came to my house and spent 45 minutes with me. She was a pleasant young lady, who had previously worked as a nurse in orthopedics and then changed track to go to NP school. She was employed by Coventry to make house visits on people like me. She had no idea that I was a physician.   She never asked and I never volunteered the information. I wanted to just be a patient and she how she performed.

She had a tablet to record her information. She went through the questions as fast as she could, not looking for any result that would send her to another screen requiring further data gathering. Then she took my blood pressure.

She did not roll up my sleeve .

She did not place the scope any where near the antebrachial fossa. She just touched it to the upper inner portion of my upper arm. She did not press hard enough to hear all 4 Korotkoff sounds. I wonder if she knew what those sounds were or who Korotkoff was or even cared.

She weighed me on her scale. It was 10 pounds off from my scale.

She quickly briefly shined her light into my mouth and ears and eyes, through my glasses, and had me say ahh. She looked at my ankles. She smiled and finished recording her findings.

In my humble opinion, she did it all wrong. The history was incomplete and therefore useless. The exam was done wrong and therefore erroneous. But she checked all the boxes on her iPad and told me that I could have the information emailed to me in about 3 weeks.

The next day I saw my personal physician, an internist and a major Midwestern clinic which has medical school, research and world class reputation. I had a sinus infection and needed medication.

The young person who escorted me to the exam room had the most lugubrious expression on her otherwise un -emotional face. We were behind a patient in a wheelchair who needed help to get on the scale. She, who never gave her name to me and whose name was only on her name badge, made an executive decision not to weigh me or obtain anything other than a temperature.   I think it would have required waiting for the wheelchair bound patient to move through first and she did not want to put that much time into vitals.

By the way, the area where weight, height, and temp are obtained is right in the open area in front of the check out desk, where all patients, coming in and going out, are triaged. Privacy? – over-rated. HIPAA – who needs it?

In the exam room, she sat at the computer and began to read my list of medications. Of the 10, nine of which are vitamins and supplements, there were three she could not pronounce.   I suspect she could not define the purpose of most of them. She certainly had no interest in getting it right.

She then explained that she marked “ weight declined” on her list of check off boxes because she did not weigh me herself. How is it that I DECLINED a weight when she actually decided not to bother obtaining one? She said she could not accept the weight done yesterday by the Coventry health care NP and just wanted me to know what she had to say on the computer. It is now her story verses my story if it ever comes up for question.

Both she and my doctor had the word “caregiver” on their name badges. He had been demoted from physician, doctor and even provider. She demoted from nurse and medical assistant to the blandness of a caregiver. The man pushing the patient in the wheelchair is a caregiver. These two have a title, training and should be recognized for that. But the administration has mixed all people with health care education into a bland emotionally vapid pudding and call all of them “caregiver”. I bet the CEO has a title prominently displayed and you will definitely know who he is if you ever see him.

So, to summarize:

• The EMR, in essence, made my clinic care giver a liar.
• The EMR used by the NP is full of in accuracies.
• HIPAA was violated a lot.
• No health information was shared between the two systems just the same as no animals were harmed in the making of any movie.

I paid for all of this with my Medicare premium money and my copay. Was there quality involved? If you ask me then I would say no, but if you ask the iPad or the EMR, the answer is hell yes, because the right boxes were checked.

How many other patients are going through these same motions earnestly believing that someone is recording something important, accurately and that quality care is being given by people who give a SH&T? The sad truth of the matter is that it is not important to those who read it nor is it accurately obtained by those who are recording it.

I think it is vitally important for physicians to shuck this off and go back to the direct care model.