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Patient advocate Eric Goldfarb discusses the article “How a pregnancy test on a male patient revealed health care flaws.” Eric shares the absurd and heartbreaking story of finding a pregnancy test charge on his 88 year old father’s final hospital bill. He explains how this error was merely a symptom of a larger, systemic failure where institutional momentum often overrides common sense and patient safety. Eric details the struggle to stop a dangerous premature discharge after his father’s brain surgery and the subsequent bureaucratic fog that prevented the hospital from correcting a biologically impossible billing error. The conversation explores how patients become ticket numbers and how the simple act of noticing can be the difference between a system that heals and one that harms. Discover why advocacy often requires repeating the obvious until the system finally listens.
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Transcript
Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Eric Goldfarb. He is a patient advocate. Today’s KevinMD article is “How a pregnancy test on a male patient revealed health care flaws.” Eric, welcome to the show.
Eric Goldfarb: Kevin, thank you, and a warm hello to your listeners. Thanks for having me.
Kevin Pho: All right, so this is kind of an attention-grabbing story for those that didn’t get a chance to read your article. Tell us about the story and what exactly happened.
Eric Goldfarb: Well, thank you. First off, I will start a little bit about my background. I am not a clinician. I spent 30 years of my life as a chief information officer responsible for large complex systems and later worked in private equity as an operating partner. My career has been about how complex systems, processes, and people perform under pressure. So when I walked into the hospital as a family member, I wasn’t just seeing medicine for me; I was seeing system behavior. I am not here to tell you or your listeners how to practice medicine. This is about really good doctors and health care professionals working inside of strained systems. I am speaking from the family side of the bed, not the chart. As somebody my age, we are taking care of parents now, and I have had experience beyond just this one.
What struck me wasn’t that this was just an isolated moment. It is how easily things can drift, and there is a momentum that gets a wave all of its own. I am not asking you or your listeners to do more. I am asking how we can protect the moments that still belong to us. With that, my father was 88 years old. He worked his way through school, was in the military, and built a life in academia. He was incredibly active, traveled regularly, went to the doctors regularly, was in wonderful health, read constantly, and was constantly on the move. Then one day, out of nowhere, he developed a brain tumor. There was pressure, and he had to immediately be scheduled for brain surgery.
That was on a Friday. We went in and were told that he would be in the hospital for six days or so. The next day, 12 hours later, someone who wasn’t even on his core team basically signed a weekend discharge to get him out of the hospital. My mom is exactly the person you want taking care of you, but she is 88, and as you can imagine, he really couldn’t stand. There wasn’t a social worker, and there was no real plan. It just didn’t seem right. It almost felt unsafe that he would be discharged without some kind of thoughtful plan.
So I spoke to a very overwhelmed nurse and a new resident. Ownership was not very clear to me, so I pushed. I just said we have got to get a solution here. It wasn’t a complicated solution; it just required some persistence. Eventually, they did have a plan, and he was there for the six days. Then we moved him to a skilled nursing facility. Sadly, he did deteriorate, and it was clear that he was not going to come out of it. Hospice was the next option. As you can imagine, as a family member, you are out of breath. When a doctor tells you that hospice is the next option and that they will be the captain of the ship, it does feel like for a brief moment you can step back and realize that somebody is going to take control of this and help you through it. But sadly, we never saw her again.
To me, a promise made should be a promise kept. There was a pattern that was starting to form here. There was one quick post-surgery follow-up review from the brain surgeon, but then that was it. Then 45 days later, after my father had died, his office scheduled a visit with my dad, who was dead. That starts to become a pattern. Having said that, we had extraordinary nurses and extraordinary physicians, but they were clearly operating under extreme pressure. After he died, we paid the bill in full. Keep in mind that we were grieving. We paid the bill, and afterward, as my wits were slowly coming back to me, I started to look a little deeper. Lo and behold, there was a charge for a pregnancy test.
I said this couldn’t possibly be right. So I called up and we found that sure enough, no test was ordered. They told us we would get a refund from the insurance company and it would take 30 days. We marked our calendar and heard nothing. Thirty days passed. We came back, followed up with them, and they said: “Nope, it is correct.” I wrote back a note and said it is impossible because an 88-year-old man can’t get pregnant and something is wrong. They wrote back again stating it is correct. Trying to be very calm, I stated this is not proper. I wrote back again, and this time they were going to send it up for the review that reviews the reviewers. With physicians apparently looking into this thing, and remembering we were told there was no test ordered, lo and behold, they came back and said it is correct.
At this point, I am practically apoplectic. I called them up, tried to be as calm as I could, and they basically told me to resolve it through MyChart. That was impossible because once he passed away, his account became locked. Eventually, we gave up. The pregnancy test here is important in the article because I am using it more as a signal. It is not the point of the piece. The point of the piece is to highlight these gaps in communication that occurred here. One of the motivations behind writing this was that I just let it go for a couple of years. What was a cocktail joke and funny with my friends, including many physicians and people in the health care profession whom I would tease about this, suddenly came back to me. I decided I had to take this a little bit more seriously.
I spent a career watching how small process gaps compound in a complicated system, and what I saw in the hospital felt familiar. The billing error wasn’t surprising. It was the certainty after the reviews that was surprising. People spoke with authority that the test was correct, and people spoke with authority that he should be discharged even though he was unconscious, couldn’t stand, and couldn’t go to the bathroom. That inability to apply common sense after escalation is what prompted me to write the article. Particularly in this day and age, even with all the technology that we have, artificial intelligence, and all these wonderful tools, the basics still matter. People, process, and communication are what counts, and all of that is what drives the technology. Sadly, what I saw a lot was the technology driving really smart people. I felt like I had to get out of my chair and say something. I wrote the article thinking that of all these tools in a hospital and at a doctor’s disposal, common sense is still the most powerful diagnostic tool in the room. When you have a process and you are operating under severe metrics, momentum can sweep you away if nobody stops, takes a deep breath, and pauses. Kevin, that is what this story is about.
Kevin Pho: So when you talk to the insurance company, and there are multiple episodes in your story where some of the processes broke down, taking that test, how can they be so confident in their pushback? That flies in the face of common sense. Why were they so sure that that particular pregnancy charge was right? What kind of justification did they use?
Eric Goldfarb: That was the best part of it; they didn’t rely on the test. At first, we were obviously talking with a group called Revenue Integrity. You could tell, because I have probably seen something like this in adjacent industries, where a call center has a script. In a sense, they were just reading from a script. They weren’t thinking. They were just taking a call and dealing with a patient advocate or a family member, and literally reading a script. I am in the wave of momentum and I am not thinking. So they spoke with authority. They did this because, number one, they are disconnected from the case. Number two, they weren’t thinking about chromosomes and that men can’t get pregnant. Even if they could, an 88-year-old man certainly can’t get pregnant. And why would you do a pregnancy test?
On the second review, it was probably another person confidently reading a script. But on the third one, I can’t really give you a good answer. That is the one where they sent it up to a committee. That is where apparently a group of physicians sat around looking at it, and I just don’t have an answer. I don’t know why they confidently said it, but I do know that the test was never ordered, and that was directed from a physician who was part of the team. There is a certain amount of irony here. In health care, one of the movements over the last few decades is to standardize care and provide more algorithmic care, which is why more people are reading from scripts and are so hesitant to deviate.
Kevin Pho: Because everyone was practicing individually, the hope was to reduce individual error by standardizing care. But the irony here is that by not deviating from the script, it actually introduced some error.
Eric Goldfarb: I think that is correct. I think the thing here is that you can have a script, you can have a process, and you can have an electronic medical system. But at the end of the day, if nobody stops to ask whether it makes sense, then that mistake really becomes the plan. Yes, it is an irony. But I think the system and the process fall behind communication and people. People come first. The physicians, nurses, and health care professionals still have to think, and they still have to take ownership. That is a key piece of it. All the automation in the world doesn’t change ownership.
Here is a really good example that I see, not just in cases with my dad, but when I have gone through medical procedures with other family members. A nurse might come into the room, do something, and mark something in a chart. A couple of hours pass, and a new nurse comes in with a shift change. They might not look at the chart, or they might look at the chart but somebody didn’t read it thoroughly, and they have to relearn everything. When you have somebody in the room who can almost own that continuity between handoffs, then that gap falls away. That is what gets lost. Honestly, there is not a system or a script in the world that fixes that because that is what we are really good at. AI and technology are wonderful at making us more productive, but that is not a substitute for thought. The human mind is amazingly imaginative and quick. I think it is going to be years before AI ever takes that off the table. That is what still has to come forward.
Kevin Pho: In the earlier part of your story where your father was discharged on a weekend, from what I know about the hospital, there tend to be skeleton crews on weekends. The nurses and physicians who took care of your father during the week aren’t the same physicians who are in charge of a weekend discharge. You, or the family members, are actually the continuing thread that can help maintain that continuity of care.
Eric Goldfarb: I agree with that a hundred percent. Yes, I agree. Obviously, it has been a couple of years, and I have had a chance to think it through. I have to agree with you that you can’t run an organization like this with perfect continuity. That is certainly understandable. Having said that, one of the things I learned is that if I had to go through this over again, I would go in asking who owns the moment. No matter what scenario you are approaching, you know there are going to be gaps, misses, and handoffs, but you need to know who owns the moment. It is really incumbent on the family member attending with the patient to step up and fill that gap themselves.
It would be really slick if there was such a thing as a health care project manager who could own continuity of care from the moment you go into the ER to the moment you go through skilled nursing. But in the absence of that, I think you are spot on. It really does have to be the family member. That highlights the importance of this patient advocate role.
Kevin Pho: From your perspective as a patient, and it sounds like from your background you do have experience in systems management in other industries, what are some of the root causes in health care that lead to these outcomes? Without being inside the room in health care, just from an outsider’s perspective, what do you think is wrong and how would you go about fixing it?
Eric Goldfarb: The first thing I would say, and I want to stress this again, is that we met some extraordinary people who are fun to talk with and super bright. Like any of us, we are human, and we are probably stronger at 7:00 a.m. or 8:00 a.m. than we are at 8:00 p.m. after a 12-hour day. The first thing to realize is that people are under pressure and they are good people. Having said that, the first thing is you have to be explicit about accountability. Say: “I am your point person.” If a physician makes a promise to be the captain of the ship, then be the captain of the ship. See it all the way through, and come back to the bridge. If you made a promise to circle back, then circle back. If you have an electronic medical care system and you know a patient is dead, don’t schedule an appointment with him. A promise made should be a promise kept. That is human and pretty straightforward.
Another thing that I used to do in my industry and I think helps here is stepping back. If I was a physician, even working on a slightly staffed weekend, I would create a moment. This is the moment I own. Ask yourself what worries you the most about this. I love my mother dearly, but all they had to do was look at her. She is 88 years old and in no position to deal with somebody who has tubes coming out of them. Just ask what worries you. That alone would have gotten to the next question, asking what I would have done if this was my father. In a sense, you want to check yourself real-time in life.
The other thing is to make transitions visible when a nurse leaves a room. Maybe put something in the record, but sometimes just a sticky note on the door makes a transition visible. What happens if the patient advocate or the family member stepped out to go to the bathroom? If that continuity of care doesn’t exist, figure out a way to make that transition visible.
This is super important: physicians are busy and the system is a pressure cooker. Acknowledge that constraint. People understand that, but that doesn’t mean that you have to disappear. Say that you are really busy, but this nurse is going to take care of you, and you will circle back to make sure that happens. It is a validate and then act kind of approach. Sometimes I have found that common sense is hard to apply when you have worked a long day, but if you say it out loud, it helps. If you say a man can’t get pregnant, and an 88-year-old man can’t get pregnant, then all of a sudden you start thinking about it.
Ultimately, what I am getting at here, Kevin, is that you really want to protect the pause. As busy as you get and as fast as workflow moves, judgment still belongs to the health care professional. That final moment is yours. Take a breath and ask yourself these questions.
Kevin Pho: Now after reflecting on the story, give us your top tip to other family members who may be going through a similar ordeal, because what you are describing happens thousands of times every day in every hospital in our country. What is your top tip?
Eric Goldfarb: I think the first thing is to take a deep breath and realize that these are good people working under pressure. Look for one visible owner of your case, one person making sure they are closing the loop and promising that things happen. If that can’t be achieved within the tools of the hospital or the clinic, then it is incumbent on the family member to step up. The fact is the system is going to keep moving no matter what. It has to, and I get it. It is just going to be important to step up and look for that owner.
Kevin Pho: We are talking to Eric Goldfarb, patient advocate. Today’s KevinMD article is “How a pregnancy test on a male patient revealed health care flaws.” Eric, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Eric Goldfarb: I would leave the audience with the thought that the system is going to keep moving whether you want it to or not, and it has to. The moment that something doesn’t fit or doesn’t make sense belongs to you. Taking a pause is a small action. It doesn’t require heroics, and it doesn’t require a system. Common sense is still the most powerful diagnostic tool in the room, and it requires someone willing to say that we need to look at this again. That is where trust lives to me.
Kevin Pho: Eric, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.
Eric Goldfarb: Thanks, Kevin.
