Carolyn Oliver, M.D., J.D.
Dr. Oliver went to medical school because she wanted to help people, and because she found medical science fascinating.
After a first-year residency (internship) in Internal Medicine, Dr. Oliver left the program to go into general practice, and also practiced as an emergency room physician.
In order to convey Dr. Oliver’s motivation in becoming an ardent patient advocate, it’s probably easiest to relate a few of her experiences.
During medical school she witnessed a few residents and just one professor who acted arrogantly and insensitively towards patients, but the vast numbers of other professors in those years showed sensitivity and kindness, and offered and insisted on top-notch medical care for all patients.
But in her first year as an emergency room doctor at a community hospital, she became alarmed at a few things that seemed to be going on with some of the doctors around her, and was tolerated by the other doctors.
To continue learning and honing her skills, after she would admit a patient to the hospital from the emergency room, on her next shift, she would go up to the floor to check the patient’s chart and see how the patient was progressing: Was her initial evaluation valid, or was she off-base? Were there things she could have done differently in the ER that would have helped that patient? Did that person need to be admitted to the hospital as she had thought?
(Unlike in TV dramas, once a patient is admitted to the hospital by an emergency room doctor, the complete care of that patient is passed to the “admitting physician” who then oversees all care of that patient, and the emergency room physician is no longer involved at all.)
What she found when she looked at the hospital work-up of many of the patients was puzzling. At first glance, many of the patients were getting brain scans. This was curious—why did so many patients need brain scans? She found that, upon questioning, these patients had admitted to having headaches. But she was never taught to order brain scans on every patient with an occasional headache. OK, just a difference in training, she thought.
Later she found that the hospital radiologist was caught giving kickbacks to doctors for ordering more x-rays.
That was the first, but unfortunately only the beginning, of instances where she has personally witnessed cases of fraudulent, and just wrong, medical care, where it was obvious that the doctor was not following standard medical care, and was instead recommending care that was good for his wallet instead of what would be usually recommended for the patient in that situation.
The cases are too numerous to recount. And what she found when she talked to other doctors who didn’t practice this type of medicine, was that they felt there was nothing they could do about what other doctors did. At one point she talked to a member of the Texas Medical Board about the practices that she was seeing, and he told her that the medical board has limited funds and time, and so can only deal with the physicians who are blatantly dangerous or addicted—that the other things just are what they are.
This wasn’t good enough. She went to law school, believing that there might be a legal remedy to this problem. But a law school education only showed her that each instance of a doctor choosing to give advice that would enrich him, even though not recommended by any other medical authorities, was not an action that the legal system had a solution for.
In addition, when she worked at a legal clinic during law school, she reviewed the medical records of clients who were applying for disability, and found that incredibly sloppy and inadequate medical care had been given to many of these patients. These patients had seen doctors for their illnesses over the years—showed up for appointments, and took blood tests and their medicines—but their diseases of diabetes and high blood pressure, for instance, were allowed to stay out-of-control for years, with the doctor signing off each chart with “return in 3 months” or whatever.
Those patients believed that they were being adequately treated—they were seeing the doctor regularly—and yet they were now applying for disability because of end-stage disease states—because their doctors did not adequately treat them.
These things are just wrong. There is a fiduciary relationship between doctor and patient, where the doctor must put the patient’s interests above his own; but the law does not have the teeth to enforce this, and some—too many—doctors don’t honor it.
Of course there are good doctors. Of course doctors have too much to do and too many bureaucratic responsibilities now. But how much fraudulent or inadequate care is too much, when patients are unaware of what is going on, and those who can see what’s going on believe that there is nothing they can do?
Fortunately, others were seeing the problems in achieving quality care in U.S. medicine. In 2000, the Institute of Medicine published their groundbreaking work, “To Err Is Human,” which chronicled the fact that as many as 98,000 patients die every year in U.S. hospitals due to medical errors. In addition, that report brought attention to the medical literature that showed the widespread practice of inadequate treatment and the widespread practice of out-dated treatment of patients with acute and chronic illnesses, in addition to the problems of “overuse” practiced by some physicians.
Dr. Oliver founded Patient Always First in Houston, Texas in 2004. One of its goals is to educate and empower patients to get better medical care. Patient Always First offers a personal health record at www.pfhr.org.
Dr. Oliver has funded several Texas Medical Association Foundation projects that address ethical and quality issues in medicine. She has produced a TV pilot/video series, Misdiagnosed, that relate the stories of patients who have experienced tragedies in the healthcare system that might have been avoided with more knowledgeable patient and family participation. She founded the Oliver Center for Patient Safety and Quality Healthcare at the University of Texas Medical Branch (UTMB), Galveston, Texas (www.utmb.edu/olivercenter). Her 2009 book, “Cautious Care: A Guide for Patients,” is offered at Amazon.com, and she offers commentary and advice on healthcare at www.DocOliver.com.
Dr. Oliver lives with her husband and their college-age children in Houston, Texas. You can contact her at carioliver@aol.com, or at 713-705-9961.