Final Read

Q: Tell us about a time you effectively handled a crisis.final read

The practice of clinical medicine is fraught with unforeseen daily crises, which may result in patient harm if left unattended.

As a private practice neurointerventional radiologist in a rural area, I have seen the full gamut of cases — from gunshot wounds to moose versus pedestrian accidents. Patients can spend 3-4 hours in the car driving to our hospital for procedures not offered in more remote parts of the state.

A local 72-year old woman with a T11 compression deformity secondary to osteoporosis was referred to me for evaluation early one morning. It was apparent from her history, physical exam, and MRI findings that she was a candidate for vertebroplasty. Since she was a Medicare beneficiary and had failed only medical therapy requirements, it was unclear if she would be billed for this service. Why? The patient, according to recent guidelines, did not satisfy all conservative treatment measures. Unfortunately, it was my responsibility to describe her to the potential financial implications. She and her family were visibly upset and unable to afford more medical bills.

"It was a process that consumed a large part of my day as well as the dedicated work of many other individuals, but it resulted in complete resolution of the patient’s pain.” — Charles W. Bowkley III, M.D.

Through the rapid coordination of our nursing team, our physician assistant, multiple administrative assistants, the referring physician, and a local physical therapist, we were able to satisfy the new guidelines and treat the patient that afternoon. It was a process that consumed a large part of my day as well as the dedicated work of many other individuals, but it resulted in complete resolution of the patient's pain.

While this crisis was not equivalent to the Exxon Valdez oil spill, for example, it was monumental for my patient and her family. However, only through communication and teamwork were we able to treat her pain and ease her suffering.


final read headshotCharles W. Bowkley III, M.D.
Neurointerventional Radiologist
Department of Radiology
Casper Medical Imaging
Casper, Wyo.

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