Reconciliations

reconciliation
noun
1. the reestablishing of cordial relations
2. getting two things to correspond; "the reconciliation of his checkbook and the bank statement"

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About a week ago, it was time to sit down and pay the bills. Being a computer nerd, I generally find that paying by bills on-line is quick and efficient. I use Quicken and pay bill after bill fairly quickly. The program then logs on to my bank and uploads by payment requests and downloads mysterious transactions that my wife performs throughout the week. I am glad she handles many of the family chores as efficiently as she does.

But the other day a great big “cash advance” was noted on my debit card. Hmmm. “This just happened yesterday,” I thought. Wow, it’s for an awful lot of money – way more than I thought I could withdraw on my card. And it was cashed at a USAA Bank. Hmmm.

“Honey?”

“Yes, dear?”

“Did you withdraw some cash (to the tune of well over a $1000 – exact amount not to be disclosed) to a USAA Bank?”

“No.”

So I called USAA Bank and gave them the cryptic series of numbers on the electronic transfer and asked if I happened to be at their bank yesterday if I received a cash advance. They had no recollection of such a transaction and noted I did not have an account with them.

“And where are your banks?”

“We only have branches in Texas.” Hmmm. Now maybe this was the same yahoo that tapped into GruntDoc’s account, I don’t know, but I live in Illinois.

“We suggest you call your credit card company.”

Which I did. St. Elsewhere Bank in St. Elsewhere. I gave them that cryptic number on my bank statement.

“Just a moment,” the helpful person said on the other end of the line. A few minutes later she said, “this is was withdrawn from your credit card that ends in the digits, 2212 (not the real numbers).”

“Uh, I don’t have such a credit card from you.”

“Just a moment.”

Well now I’m pissed. But it could have been much worse. I luckily learned that my account had been violated under 24 hours prior. By mere luck, I had logged on and noticed the transaction and called my bank. I learned in all my escapades that debit cards (even debit cards you don’t own) have a limit on how long you can be before notifying the bank about fraudulent charges – 48 hours. Unlike credit cards, they are not as “secure” and the odds of getting any money back after using a non-signature card is much less likely than with a signature card. Fortunately, my card company has credited by account with a “provisional deposit” pending the investigation for the amount transferred, but I was lucky. And I also have learned about this problem with TJX Companies (TJ Max, Marshalls, HomeGoods, etc) - it seems they had a massive intrusion into their computer systems. My wife shops often at these stores. And her name, address, driver's license number and social security number and 45.7 million credit cards have likely been lifted. Needless to say a police report has been filed (may they please see who did this on the USAA Bank video…).

SOOOOO, what the heck does all of this have to do with MEDICINE???

Well, yes Virginia, there’s more. It seems we ALL have to do more reconciling – every day. Oh, not of bank accounts. No.

Of medications.

Yep. In case you haven’t heard, the Joint Commission has decided that ALL patient medication lists must be reconciled ANY time there is a transfer of patients between ANY facilities, care units, or providers. It’s part of their 2007 National Patient Safety Goals. Sections 8A and 8B, to be specific. And we’ve heard their “dropping in” on facilities around our area to see how well folks are complying.

What, you don’t know about this? Either did I until today, when the 17-page ’frequently asked questions’ about this initiative landed in my hands from a nurse. She was “pleased” to say the least.

“What are we gonna do about this? It says we have to give the patient a printed list of all of their medications with easy-to-read instructions when they leave the clinic or hospital any time there is a change to those medications. How are you going to DO this, doctor? Why does this fall on US?”

Well, I certainly understand the need to reconcile things, especially after my bank statement fiasco, but boy, have we got another time-consuming and tedious task just handed to us. Many of my patients have over 12 medications, not to mention vitamins, and occasional vaccinations, and in some cases, even fluoride treatments, that we are supposed to reconcile EVERY TIME a patient leaves our clinic or hospital. I’m not kidding. There’s even a flow chart on what to do. Will patient’s even want this list? Worse still, what impact will repetitive lists sent to referring physicians have in the outpatient care arena – will these notifications eventually be treated as spam in their inbox? Delete. Delete. Delete.

But it’s all in the name of safety and all during a 20-minute follow-up patient visit or every time a patient transfers between care arenas.

But perhaps there is a tacit agenda at play here. Perhaps this initiative is another means of driving a stake into the heart of the paper medical record. After all, only an electronic form of information can make this initiative even possible. Who the heck has the time to manually write a long list of medications each time the patient leaves their office after a single medication change?

While many of the 2007 National Patient Safety Goals of the Joint Commission are based on a sound premise, that is, reduced medical errors and improved safety for our patients, every one of these initiatives has the potential to impact other areas of health care delivery. This requirement, while noble, may also drive a stake in what little remains of the doctor-patient relationship and in effect, be anti-reconciliatory, since doctors will spend more time documenting and less time looking and speaking to their patients.

-Wes