OpenHealth Q&A

Concerns Over Recent Primary Care Provider Errors

Patient Profile: 76 years old, female, 5'6" tall, weight 155 lbs, Caucasian. Current health issues include hypertension (managed with amlodipine at 3.75 mg daily), mild hyperlipidemia (treated with Crestor at 2.5 mg daily), hypothyroidism due to Hashimoto's disease (on levothyroxine 50 mcg daily), severe spinal stenosis (managing with Tylenol at 3300 mg and Aleve at 220 mg daily), pre-diabetes with an A1C of 6.0 (taking chromium picolinate), and mild osteopenia (scored -1.0 on a Dexa scan conducted in 2024, supplemented with vitamin D3, K2, C, and calcium). Additionally, there is reported bilateral foot neuropathy likely associated with spinal stenosis, though the exact cause remains undetermined, along with mild GERD symptoms. The patient also takes Co-Q10 and vitamin E supplements. Surgical history includes a hip replacement in 2024 and a planned hysterectomy/oophorectomy in March 2025. Anticipated spine surgery consists of a one-level spinal fusion and two-level laminectomy set for August 2025. The patient has never smoked, drinks infrequently, and occasionally uses cannabis for back pain relief. Primary Concern: The patient is experiencing significant issues with their new primary care provider (PCP), who appears to be making serious errors in medication and lab orders. The extent of these mistakes is unclear, possibly stemming from communication gaps, but these difficulties are compounded by interactions with the provider's staff through an online portal. Having switched to this new PCP just a few months ago, the patient is now contemplating yet another change. Prior experiences with the former PCP were unsatisfactory, as they overlooked the management of the patient’s hypertension and hyperlipidemia, falsified telehealth examination records, imposed lengthy waiting times for appointments, acknowledged their own exhaustion, and demonstrated inappropriate behavior during consultations. Consequently, the patient decided to transition to a new provider. The current provider is a nurse practitioner. Initially skeptical of non-MDs, the patient found her to be knowledgeable, empathetic, and easy to talk to compared to the previous internist MD. During a recent telehealth appointment, the patient mentioned needing a refill for levothyroxine but learned that a TSH test from the past year was required for further prescriptions, which sounded reasonable given the lack of refills remaining on previous orders. The patient has conducted personal blood work via LabCorp’s OnDemand service to maintain health awareness, noting a TSH/fT4 test was performed in July 2024 alongside A1C and lipid panels, and a CMP/CBC test was conducted in April 2025 following a challenging recovery from a hysterectomy complicated by a severe UTI. Informing the NP of the previous TSH testing sufficed for a one-month prescription, but the NP indicated a need for a fresher test result for a more extended prescription. After agreeing to have the new TSH ordered by LabCorp, the patient forwarded the official LabCorp report for the July 2024 TSH and included the CMP report from April 2025 for her records. Rather than a straightforward order for the TSH, the NP unexpectedly ordered an extensive panel including TSH, lipids, A1C, and CMP. Given that the spine surgeon required blood work not older than a month prior to surgery and the patient had already completed a CMP recently, this new order posed logistical challenges. Additionally, the patient expressed the need for a referral to a GI doctor for an overdue colonoscopy, especially since their previous doctor had retired. Although the patient’s insurance typically does not necessitate referrals, finding a doctor within the same healthcare network was ideal. The NP proceeded to provide the referral but inexplicably sent a prescription for SuPrep, unbeknownst to whether the new GI doctor even prescribes it and without the patient having had seen the new doctor yet or needing the colonoscopy any time soon due to the upcoming spine surgery. Frustration with communication ensued, as the patient's attempts to clarify details with the NP and her assistants revealed disconnects in understanding, with staff disclaiming any involvement in ordering the SuPrep despite its appearance in the pharmacy system linked to the NP. After a drawn-out week, the visit notes confirmed the NP did indeed authorize the SuPrep. The patient reiterated the urgency for other lab tests necessary for surgery preparation, explained their inability to manage blood work ahead of July 15, and highlighted the redundancy of ordering a CMP so soon. She expressed her rationale for declining the SuPrep prescription, stating she was unwilling to fulfill the order at this time. Receiving assorted responses from the NP's team, advice varied widely, including one assistant suggesting pausing the SuPrep until the colonoscopy was scheduled. Ultimately, the patient firmly requested that the NP only order the needed TSH/fT4 test, acknowledging a desire not to appear excessively demanding, though feeling justified about the situation. Currently awaiting a response, the patient is left pondering if the communication issues are partly her responsibility. This ongoing predicament has added unnecessary strain to her already pressing spine surgery situation. It prompts reflections on how an order for a bowel prep could arise simply from a request for a GI referral, questioning the rationale behind the unnecessary lab orders and the significant delay in receiving visit notes. Seeking genuine feedback on navigating such healthcare challenges.

Answers (1)

6/27/2025, 2:50:55 AM

OpenHealth AI

Navigating healthcare challenges, especially with issues like medication errors and communication difficulties with providers, can be very stressful. It’s understandable that you feel overwhelmed, given your multiple health conditions, upcoming surgeries, and the frustrations you’re experiencing with your current primary care provider (PCP).

Key Points:

1. Communication Gaps: Your concerns about poor communication and unnecessary lab orders are valid, particularly when managing complex health issues.
2. Workflow Errors: Mistakes such as ordering the SuPrep without a scheduled colonoscopy are concerning and could indicate underlying issues with the office's processes.
3. Prioritizing Care: Focusing on what is essential for your upcoming spine surgery and overall health management is crucial.

Explanation:

It's essential that your healthcare team accurately understands your needs, especially when dealing with multiple conditions. Repeated and unnecessary tests can lead to confusion and delay care, which is particularly inappropriate given your planned surgery.

Next Steps:

1. Clarify Your Needs: Consider drafting a clear, concise list of your immediate care needs (e.g., essential lab work for surgery, a GI referral, etc.). Share this with your NP or their office to reduce confusion about what you need.

2. Establish Direct Communication: Request a direct line of communication with your NP or a designated staff member for urgent concerns, as this may help mitigate misunderstandings.

3. Document Everything: Keep thorough records of all communications, prescriptions, and lab orders. This can help you track what has been requested or prescribed and ensures accountability.

4. Advocate for Yourself: If unnecessary orders or errors continue, don't hesitate to clearly express your concerns in follow-up appointments. It’s important to advocate for your care and have your voice heard.

5. Consider Alternatives: If you find that the communication issues persist or worsen, and given your previous experiences, it might be worth considering a different provider, even if it feels daunting. A supportive provider is crucial, especially as you manage multiple health conditions.

6. Prepare for Your Appointments: Before each appointment, prepare what you want to discuss, including what you expect from the visit. This preparation can help keep the meeting focused and productive.

Remember:

You deserve clear and effective communication regarding your health, especially with the complexity of your medical needs. It may be challenging, but advocating for yourself is vital to ensure the quality of your care. You're not alone in facing these frustrations, and it's okay to seek better care that meets your needs. If you require further assistance or specific strategies, feel free to reach out.