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shrink 02-02-2015 05:40 PM

Medical Providers: The Good, the Bad, and the Ugly.
I am posting this as a way of sharing experiences my husband or I have encountered in the Villages, in the hopes that others may benefit:

To avoid having to do a bunch of re-typing, I will start off by pasting the text of a letter I wrote in early January to the director of Premier Medical Associates (Santa Barbara location):
January January 8, 2015
Director; Premier Medical
Dear Dr. Khanna,

I was seen at your Santa Barbara urgent care facility by (XXXXX) on 12/19/2014, presenting with lower left abdominal pain and cramping, with a low grade fever. I told the doctor that I felt I was having a diverticulitis attack, as I had experienced it one time before and recognized the symptoms. The extent of my physical exam by Dr. (XXXXX) was to have me stand up and point to the locus of the pain. He then poked the spot and asked me if it was tender. He never had me lie down to look for masses, did not listen to my heart or lungs, or perform any other kind of exam. I was diagnosed with “LLL abdominal pain”, and prescribed a 7 day course of Ciprofloxin.
I requested a copy of my exam notes (none had been offered me) upon discharge. The note I received was “boilerplate”, spelling out an exam which was never performed (i.e., “RESPIRATORY; normal rate and pattern, normal breath sounds with no rales, rhonchi….CARDIOVASCULAR: no murmurs, carotids: 2+ amplitude…”, etc.
Further, the discharge note stated that I had been given a handout on abdominal pain. I was given no handouts.

As my symptoms did not resolve properly, I was subsequently seen by my gastroenterologist. She was surprised to hear that no C-T scan had been ordered, and yet, I was prescribed antibiotics. Further, if diverticulitis had been suspected, I was placed on only 7 days of one antibiotic, when the standard for treatment is two antibiotics for 14 days. As a result, I have had to start all over again with antibiotics!

In summary, I was not properly examined, a falsified report was given, and I was not properly treated. Regarding the falsified discharge report, I believe that this submission is in violation of Medicare standards at a minimum, and certainly, very poor medical practice.

I will not report this incident to Medicare at this point, but I would like a written response from you regarding the practices I encountered at your facility, as well as a plan to correct them for your subsequent patients.
I look forward to hearing from you.

I want now share that I NEVER HEARD ONE WORD back in response to this letter. That slight speaks volumes to me. Please, fellow Villagers, exercise caution when choosing a facility.

Now, to go to a positive note: Our experiences with the Villages Health Care System (Santa Barbara) has been nothing short of amazing. Our doctor and PA are tops, the organizational system at the facility is flawless, calls are always returned, and our primary care doctor even calls us back to check on our progress when we are ill. We had to kiss a few frogs before finding this place, but or search for excellence in primary care is over.

Please folks, if you've head very positive or very negative experiences in TV, consider sharing them with others. Its a very good thing to do. :)

blueash 02-03-2015 01:44 PM

Sadly, you have experienced the joy of pre-written exams courtesy of the electronic medical record. Just click one button and the exam is entered in the record. It may or may not be this doctor's routine to actually examine the patient more thoroughly than you were examined, or not. However, it sounds like the doctor made the correct diagnosis of diverticulitis from your history and the brief exam your received. 90% of diagnostic information is obtained from the history.

Here is the key sentence from the recommendations of the American Society of Colon and Rectal Surgeons regarding diagnosis of diverticulitis:


A diagnosis of acute diverticulitis often can be made based on history and physical findings especially in patients who have had a previously confirmed diverticulitis
In patients where the diagnosis is uncertain then CT is the preferred diagnostic test. Everyone should be aware of the very high dose of radiation delivered by a CT and in a patient with a reasonably clear diagnosis who is not toxic it would certainly seem reasonable to treat and advise the patient to follow up with their primary care provider, or in the OP's situation where the OP seems to have already had a gastroenterologist, to follow up with that person. It is not the role of an urgent care doctor to provide complete care, just to evaluate whether you have an urgent situation, provide temporary control and get you back to your established providers.

As to the utility and duration of antibiotics for management of diverticulitis
Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis - Chabok - 2012 - British Journal of Surgery - Wiley Online Library

Mild colonic diverticulitis can be treated without antibiotics. a case–control study - de Korte - 2012 - Colorectal Disease - Wiley Online Library

Use of antibiotics in uncomplicated diverticulitis - de Korte - 2011 - British Journal of Surgery - Wiley Online Library

And this study comparing 4 days of therapy versus the "standand" of 7 days

Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis - Springer

Antimicrobial Therapy for Acute Colonic Diverticulitis

And there are many many more. No where did I find a study saying the correct duration of oral antibiotics is 14 days. So that is your GI doctor's preference but not based on any recommendation I could find. There is nothing wrong with 14 days, but there is a very very big difference with a doctor saying, " I prefer 14 days of antibiotic" vs saying "14 days is the only correct management and your previous doctor mis-managed you".

So in summary you presented with abdominal pain to an urgent care where the correct diagnosis was made without exposing you to any unneeded testing or a CT. An antibiotic was given for a period of time well within the recommendations in the literature. Whether two antibiotics (?metronidazole) was also "needed" is not established but is done by some.

I do have issues with the paper work and the errors in documentation. I am also unhappy that they did not reply to your letter. And most importantly, you seem to have gotten better. Hopefully your GI doctor gave you explicit directions on how (s)he wants you to handle your next episode should you have it again.

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