doctor's permission forms/ambience--doctors welcome

I am starting a new thread rather than highjacking CaliCash’s.

Although my internist was almost certain that a growth on my back wasn’t cancerous, she referred me to a dermatologist. It was squamous cell cancer. I had Mohs surgery and it’s all out… The Mohs was done by a different doctor in the same practice.

I’m a lawyer and I dislike signing forms that are a pack of lies. Before the Mohs surgery, I had to sign a form which said that I was only having this one growth treated and that the practice wasn’t responsible if any other growth I had was cancerous. If I didn’t sign it, I couldn’t have the procedure. This is the same practice where I went for a full body scan. The form also said I had been told of other alternatives and had elected Mohs. No such discussion occurred.

The news I had squamous cell cancer was given to me by some staff member. All I was told was that I had squamous cell cancer, I needed to schedule an appointment immediately, it would take several hours, and might involve multiple visits. When I tried to ask questions, I was told I could read the pathologist’s report in the “portal.” When I did, I learned that 11 days had elapsed between the practice’s receipt of the report and the phone call to me. The first time I was told that my cancer wasn’t very deep and wasn’t at all life threatening was immediately before the procedure.

All of my visits took place in rooms where I was surrounded by ads with bikini clad women advocating for the benefits of “full body sculpting.” and for botox treatments.

Additionally, I don’t have a smart phone and the practice seems to assume everyone does. I got notices I couldn’t open. I listed a preference for getting calls on my home phone on the office forms–that’s the only way the practice never contacted me.

I am supposed to go back to have some sort of face peel at the end of August as my face is apparently covered with precancerous spots. (Several larger ones were burned off). I don’t think the doctor is wrong in saying this, but I just don’t like the way this practice operates. Am I being silly? Is it standard these days for doctors to force you to sign CYA permission slips which claim they did things they didn’t do?

Consents are important for any procedure in medicine. You need to be told risks, benefits and alternatives and allowed to ask questions or don’t sign. But you can be a reasonable patient too.
Many dermatology offices are selling a lot of cosmetic treatment but others don’t. Got to one that doesn’t.
If you’ve ever been to a car dealership you got a bad feeling about you walk out and go to another, same with doctor.

Jonri, sorry about the cancer and glad you had the procedure. The last time I went to a dermatologist to be looked over for “bad” moles, I got the impression that the doctor was bored and that the whole office was geared toward cosmetic procedures.

I also hate hate hate the forms and releases.

. How are those not contracts of adhesion?

I had a gynecological procedure done almost three weeks ago to diagnose a problem that might or might not have been endometrial cancer. I was told that I would receive a call when the pathology report came back. I never got a call. I never heard – officially – that the results showed that I did not have cancer until my follow-up visit today.

One might assume that this means that the report wasn’t available until today. After all, patients worry about these things, and of course a doctor’s office would want to tell the patient the results (especially reassuring results) as soon as possible. But this assumption would be wrong.

Eight days ago, I happened to visit my primary care doctor’s office for an unrelated reason. And she had the pathology report. She let me read the findings right off her computer. So obviously the report existed more than a week ago. It’s just that no one from the gynecology practice bothered to call me.

I don’t have a smart phone either. Maybe that’s the problem. But I do have a home phone, a cell phone capable of receiving text messages (where I get texted appointment reminders), an office phone, an e-mail address (where I get notifications of new updates on the patient portal), and a mailing address. Somehow I think they could have found me if they wanted to.

There’s really no excuse for such sloppiness in handling patient communication regarding a test to rule out cancer. This isn’t just an ordinary Pap smear for someone with no risk factor and no family history, but cases where cancer was known to be present or heavily suspected. No excuse!

Time to get a new dermatologist!

I have had both basal cell and squamous cell removed with mohs. I also did the topical cream (chemotherapy) to remove precancerous cells. Everything was totally explained. I felt like the whole staff, doctors, nurses and clerical, were my sisters and we were all in this together.

Nothing like that in the consent forms I signed. I would not stay with a practice that wanted me to sign something that wasn’t accurate.

I had a medical procedure done recently where I was given a consent form so badly printed that I couldn’t read it. The doctor apologized and said there was a problem with the printer. But the fact is that I didn’t know what I was signing.

I signed it anyway. Maybe I shouldn’t have, but this was the type of procedure that required me to have someone to drop me off and pick me up, and the person I had asked to be my driver had gone to a great deal of trouble to get the day off from work. I didn’t feel that I could impose on my driver to get another day off after the printer was fixed.

Perhaps another patient sued for an issue that was not part of their treatment that led to this being included in their office release form.

Well, maybe. It depends on your priorities.

I have a vast and ever-growing collection of moles, and I have had dozens of biopsies, one skin cancer, and endless procedures to remove precancerous spots (actinic keratoses). At my current dermatologist’s office, I sign consent forms that have a lot of stuff in them that doesn’t seem relevant. But it’s better than going to my previous dermatologist. His consent forms were fine, but his office had roaches. I sympathize with the difficulty of keeping insects out of older buildings, but when you’re doing invasive procedures in an office, it really shouldn’t have roaches.

If you don’t like the doctor, find a different one.

The description of events in the OP is Standard Operating Procedure for practices in this area, not just dermatologists.

Mandatory signatures releasing the doctor from liability - check
Actually, virtually all doctors’ offices around here mandate a signature on a binding arbitration agreement at the time of the first visit.

Delays and miscommunications over test results - check

Ineptitude of the office staff and doctor not communicating important information directly to the patient - check

The consent form stuff drives me nuts too. The worst for me was when a staff member handed me only the last page of a consent form, with the last few words of text and a signature line. Uh, no, I’m not signing that.

I try to make it a practice of telling the doctor when there’s a problem with the consent, or sometimes I just cross out parts that don’t apply and I’ve never been called on it. On the Moh’s surgery form, I’m sure if you had shown the doc the form and told him/ her that other options hadn’t been explained he/she would have given you a 30- sec overview of “alternatives,” but that wouldn’t have been all that useful either.

My fantasy solution is to write “too sick; didn’t read” on the signature block, but the risk of being identified as a smartass right before surgery is too great. But i always wonder if anyone would notice.

I always ask when test results will be ready and call on that day.

The arbitration agreement is the one part of all the forms that you can’t just cross out or ignore. It’s mandatory and non-negoriable for every doctor I’ve ever seen.

An arbitration agreement is generally fine with me but I do wish the laws would change so that claims adjudicated in malpractice arbitrations were NOT kept private. Even if the doctor ultimately prevails, I think it is very valuable info for prospective patients to know how many times a doctor has been sued. Arbitration agreements protect that info from the public eye, since arbitration proceedings are private and not part of any public record.

I just came back from 6 pretty full days of extensive testing and evaluation out of state. I can recall signing consent forms, other than privacy notices and HIPAA stuff.

I would also be pretty unhappy about signing consents that misrepresented what had occurred, which it sounds like your forms did. I have had docs that misrepresented potential side effects of proposed medical treatments. As soon as my other MDs learned about this, they would warn me of scary likely side effects and I would abruptly stop treatment with such MDs.

I have a relative who is a dermatologist. She doesn’t want to do plastic surgery types of procedures and refers such patients out. She knows there is a LOT of money to be made but prefers to handle skin cancer, acne, allergies and other medical issues. Those types of docs DO exist!

I would find a new derm. The first one I went to had an office like you describe, plugging various beauty and anti-aging treatments and he totally missed a melanoma that I specifically came in to point out.

My current one saw the mole and took it right off. Called me herself with the pathology when it was malignant. Her office has no beauty products for sale, no posters except for those advising against tanning.

Eleven days is way too long. for a pathology report. IMHO the doctor or an experienced nurse should have made the call and answered ALL your questions. Even though SCC is not a “big deal” as far as cancer it IS a big deal to the patient!! And MOHS surgery is not easy to explain at first to the patient.

And whoever mentioned a doctor who does a half-hearted cody scan - again, find a new one. You should feel like a piece of meat or an antique undergoing a thorough appraisal. The doc should look between toes, have you move around, life legs, arms, bend certain ways, go through your hair, etc etc. It’s almost as bad as a gyn visit!

Sorry I can’t comment on your forms. I usually end up signing them because I just can’t be bothered to deal with arguing :slight_smile:

I had a biopsy for cervical/utareal cancer this past Wednesday. My doc seemed surprised that I read the consent. He even made a comment about how " he noticed this."

He said he would call me with the results because patients get very anxious about “the big C” until they hear. We’ ll see if he calls.

Unfortunately we are all so jaded about medicine. We need more medical doctors. Why does itt seem most, in my rural city, seem foreign? I have absolutely no problem with foreign doctors. But why do we need to import so many foreign doctors? I have been told, and read, that we limit supply in this country. Seriously, why? I’ve read that it is to insure income. ( supply and demand) But the influx of foreign doctors wouldn’t counter that. So these arguments don’t seem to make sense.

I also know most American trained doctors go into specialties because that is were the money is. I also know Medical eucation is very expensive. Somethings wtrong.

I just finished writing a letter praising my favorite doctor in the world to his boss, the president of the medical center, who happens to be an MD. I’ve been under his care for 16 years and honestly feel I owe my life to him. I’m nervous that he’s retiring as he has turned 70. He has turned me over to another doc, who I believe is also in his 70s.

Honestly, I’m a bit anxious about transferring my care from my current doctor (yes, he’s a specialist) to anyone else, as we’ve been through quite a lot together and I have been very spoiled by getting prompt and thorough responses to all my questions with my current doctor, who guides my local doctors.

I honestly do NOT read most of the medical forms I sign; I know I should but normally feel we don’t have much choice because if we want to see the provider, we have to sign the forms given us by the provider. I do have a good relationship with my physicians–all were trained in the US.

I’m especially anxious about the fact that the average age of most HI mds is rising. Most of my doctors are in their late 50s and older, or 40s at the youngest and I honestly wonder how long they will practice with the stresses of ACA and EHR etc.

My dermatologist is plain vanilla, has an office practice only two days a week (at a university hospital he other days), and has her mom as her receptionist. One summer she was on vacation when a mysterious itchy rash suddenly appeared on my leg and grew bigger every day. I got referred to the doc who was covering the practice. Her office was in a nearby swanky suburb, and I pretty much giggled at the displays and brochures in the waiting room the whole time I was there. I had never imagined an office could be dedicated to Botox and fillers. Fortunately the dermatologist seemed to still remember how to diagnose, and I got treated for a Lyme Disease bite. But I’d never voluntarily return to that kind of practice because I wouldn’t feel that the doc was practicing enough “real” medicine to engender any confidence.

What I find hard to understand is how someone can go through the hell of medical school, internship and residency and then find contentment in catering to rich women’s insecurities. I went to college with a lot of pre-meds, and none of them had that kind of work in mind.

Medical schools limit their enrollment; they claim doing so is necessary because they don’t have sufficient resources to have bigger classes. I think that’s true but incomplete; I also think that there are a lot of people in the medical profession who want to preserve the relatively high incomes of current practitioners by controlling supply. But I don’t think the desire to control supply extends to barring immigration of physicians. It’s probably hard for foreign-educated doctors to get licensed in the United States but not impossible.

“What I find hard to understand is how someone can go through the hell of medical school, internship and residency and then find contentment in catering to rich women’s insecurities. I went to college with a lot of pre-meds, and none of them had that kind of work in mind.”

Easy. Money and lifestyle. It’s one of the most in-demand specialties.

  1. Money – there is no limit to what women will spend to make / keep themselves beautiful.
  2. Lifestyle – while there are sometimes dermatological emergencies, they are few and far between. No hospital call, no middle of the night phone calls, and you’re typically not breaking life-or-death news to anyone.